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Moussiopoulou J, Pross B, Handrack M, Keeser D, Pogarell O, Halle M, Falkai P, Scherr J, Hasan A, Roeh A. The influence of marathon running on resting-state EEG activity: a longitudinal observational study. Eur J Appl Physiol 2024; 124:1311-1321. [PMID: 38019317 PMCID: PMC10954932 DOI: 10.1007/s00421-023-05356-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 10/28/2023] [Indexed: 11/30/2023]
Abstract
Physical activity (PA) has positive effects on various health aspects and neuronal functions, including neuronal plasticity. Exceeding a certain exercise frequency and duration has been associated with negative effects. Our study investigated the effects of excessive PA with a marathon run (MA) and regular PA (training and recovery phases) on electrocortical activity, as measured by electroencephalography (EEG). Thirty healthy marathon runners (26 male, 45 ± 9 yrs) were enrolled in the study. Four resting-state 32 channel EEG recordings were conducted: 12-8 weeks before MA (T-1), 14-4 days prior to MA (T0), 1-6 days after (T2), and 13-15 weeks after MA (T3). Power spectrum analyses were conducted using standardized Low-Resolution Electromagnetic Tomography (sLORETA) and included the following frequency bands: delta (1.5-6 Hz), theta (6.5-8.0 Hz), alpha1 (8.5-10 Hz), alpha2 (10.5-12.0 Hz), beta1 (12.5-18.0 Hz), beta2 (18.5-21.0 Hz), beta3 (21.5-30.0 Hz), and total power (1.5-30 Hz). Statistical nonparametric mapping showed reduced power both in the alpha-2 (log-F ratio = - 0.705, threshold log-F ratio = ± 0.685, p < 0.05) and in the delta frequency band (log-F ratio = -0.699, threshold log-F ratio = ± 0.685, p < 0.05) in frontal cortical areas after MA (T2 vs. T0). These effects diminished at long-term follow-up (T3). The results can be interpreted as correlates for subacute neuroplasticity induced by strenuous and prolonged PA. Although previous studies reported an increase in alpha frequency during and directly postexercise, the adverse observation a few days after exercise cessation suggests counterregulatory mechanisms, whose complex origin can be suspected in subcortical circuits, changes in neurotransmitter systems and modulation of affectivity.
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Affiliation(s)
- Joanna Moussiopoulou
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany.
| | - Benjamin Pross
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Medical Faculty, Bezirkskrankenhaus Augsburg, University of Augsburg, Augsburg, Germany
| | - Mirjam Handrack
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
- NeuroImaging Core Unit Munich (NICUM), Ludwig Maximilian University Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Martin Halle
- Department of Prevention and Sports Medicine, University Hospital Klinikum Rechts Der Isar, Technical University Munich, Georg-Brauchle-Ring 56, 80992, Munich, Germany
- DZHK (German Center for Cardiovascular Research, Partner Site Munich Heart Alliance), Potsdamer Str. 58, 10785, Berlin, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Johannes Scherr
- Department of Prevention and Sports Medicine, University Hospital Klinikum Rechts Der Isar, Technical University Munich, Georg-Brauchle-Ring 56, 80992, Munich, Germany
- University Center for Preventive and Sports Medicine, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Medical Faculty, Bezirkskrankenhaus Augsburg, University of Augsburg, Augsburg, Germany
| | - Astrid Roeh
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Medical Faculty, Bezirkskrankenhaus Augsburg, University of Augsburg, Augsburg, Germany
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Semler E, Herpich F, Zellner L, Zwick S, Zwanzger P, Brunnauer A. The impact of aerobic endurance training on cognitive performance in schizophrenic inpatients in a clinical routine setting. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01773-4. [PMID: 38502204 DOI: 10.1007/s00406-024-01773-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/28/2024] [Indexed: 03/21/2024]
Abstract
The primary aim of this study was to investigate the impact of aerobic endurance training in schizophrenic inpatients on cognitive performance in a clinical routine setting. Of secondary interest was the influence on psychopathological symptoms. A total of 31 schizophrenic inpatients were randomly assigned to receive either controlled endurance training or occupational therapy. The experimental group underwent endurance training of 20-30 min each, 3 times per week for a total of up to 22 training sessions. The control group received about 90 min of occupational therapy, 2-3 times per week for up to 22 sessions. Cognitive performance was assessed via an extensive neuropsychological examination before randomization and prior to discharge. Significant improvements in cognitive functions and psychopathology could be shown in both groups. For verbal memory functions (short-term memory, working memory, and learning performance), there was a significant advantage for the aerobic endurance training group. Physical exercise is a feasible, easy-to-implement add-on therapy for schizophrenic patients in a clinical routine setting with positive effects on verbal memory functions. Besides, it seems important to fill the gap between inpatient and outpatient health care, providing physical training supply for this patient group.
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Affiliation(s)
- Elisa Semler
- Department of Neuropsychology, Clinical Center for Psychiatry, Psychotherapy, Psychosomatic Medicine, Geriatrics and Neurology, kbo-Inn-Salzach-Klinikum, Wasserburg/Inn, Germany
| | - Florian Herpich
- Department of Neuropsychology, Clinical Center for Psychiatry, Psychotherapy, Psychosomatic Medicine, Geriatrics and Neurology, kbo-Inn-Salzach-Klinikum, Wasserburg/Inn, Germany
| | - Leonhard Zellner
- Department of Neuropsychology, Clinical Center for Psychiatry, Psychotherapy, Psychosomatic Medicine, Geriatrics and Neurology, kbo-Inn-Salzach-Klinikum, Wasserburg/Inn, Germany
| | - Sarah Zwick
- Department of Neuropsychology, Clinical Center for Psychiatry, Psychotherapy, Psychosomatic Medicine, Geriatrics and Neurology, kbo-Inn-Salzach-Klinikum, Wasserburg/Inn, Germany
| | - Peter Zwanzger
- Department of Neuropsychology, Clinical Center for Psychiatry, Psychotherapy, Psychosomatic Medicine, Geriatrics and Neurology, kbo-Inn-Salzach-Klinikum, Wasserburg/Inn, Germany
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University Munich, Munich, Germany
| | - Alexander Brunnauer
- Department of Neuropsychology, Clinical Center for Psychiatry, Psychotherapy, Psychosomatic Medicine, Geriatrics and Neurology, kbo-Inn-Salzach-Klinikum, Wasserburg/Inn, Germany.
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University Munich, Munich, Germany.
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Pérez-Romero N, Campos-Jara C, Pesce C, Araya Sierralta S, Cerda-Vega E, Ramirez-Campillo R, Campos-Jara R, Martínez-Salazar C, Arellano-Roco C, Contreras-Osorio F. Effects of physical exercise on executive functions of individuals with schizophrenia spectrum disorders: Protocol for a systematic review and meta-analysis. PLoS One 2024; 19:e0296273. [PMID: 38165903 PMCID: PMC10760781 DOI: 10.1371/journal.pone.0296273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/04/2023] [Indexed: 01/04/2024] Open
Abstract
INTRODUCTION Executive functions are commonly impaired in individuals with schizophrenia spectrum disorders. Physical exercise has the potential for improving executive functions and can be easily implemented as a therapeutic method. However, there are only few systematic reviews of exercise effects in schizophrenia including cognitive outcomes, and no meta-analytical syntheses of effects on "cool" and "hot" executive functions. The purpose of this systematic review and meta-analysis will be to determine the effects of physical exercise on "cool" and "hot" executive functions of adults with schizophrenia spectrum disorders. METHODS AND ANALYSIS This protocol was guided by PRISMA-P guidelines. Studies will be searched using combinations of keywords and medical terms in the Web of Science, PubMed, Scopus, and EBSCO databases. Inclusion criteria will be determined as per PICOS approach. The risk of bias will be assessed using the Cochrane RoB2 tool. The certainty of evidence (per outcome) will be assessed using the GRADE method. The meta-analyses will be performed using the DerSimonian and Laird random effects model. Effect sizes (Hedges' g) with 95% confidence intervals will be calculated for each main outcome. CONCLUSIONS The results of this review may be useful for mental health professionals to design treatment plans for adults with schizophrenia spectrum disorders, offering potential benefits related to the quality of life and cognitive abilities of this population. PROSPERO REGISTRATION NUMBER CRD42023392295.
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Affiliation(s)
- Nuria Pérez-Romero
- Exercise and Rehabilitation Sciences Institute, Postgraduate, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago de Chile, Chile
| | - Christian Campos-Jara
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago de Chile, Santiago, Chile
| | - Caterina Pesce
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
| | | | - Enrique Cerda-Vega
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago de Chile, Santiago, Chile
| | - Rodrigo Ramirez-Campillo
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago de Chile, Santiago, Chile
| | | | - Cristian Martínez-Salazar
- Department of Physical Education, Sports, and Recreation, Pedagogy in Physical Education, School of Education and Social Sciences and Humanities, Universidad de La Frontera, Temuco, Chile
| | - Cristián Arellano-Roco
- Laboratorio de Neuromecanica Aplicada, Escuela de kinesiología, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago, Chile
| | - Falonn Contreras-Osorio
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago de Chile, Santiago, Chile
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El Kirat H, Khattabi A, Khalis M, Belrhiti Z. Effects of physical activity and nutrient supplementation on symptoms and well-being of schizophrenia patients: An umbrella review. Schizophr Res 2023; 262:112-120. [PMID: 37948884 DOI: 10.1016/j.schres.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 10/21/2023] [Accepted: 10/22/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Physical activity and nutrient supplementation have been acknowledged to have moderate effects on symptoms and treatment compliance of patients suffering from mental disorders. However, there is still a lack of consensus on whether these interventions are effective on schizophrenia clinical and quality of life outcomes. Our objective was to provide a comprehensive review of systematic reviews that addressed the effects of physical activity and nutrient supplementation on treatment compliance, symptoms and improving the well-being of patients with schizophrenia. METHOD We carried out an umbrella review following Johanna Briggs Institute methodological guidance as follows: 1) Formulating a review question, 2) developing a search strategy, 3) systematic search in scientific databases (Medline, Cochrane Library, Science Direct), 4) study selection (title, abstract and full-text screening), 5) data extraction, 6) data charting and synthesis and 7) quality appraisal. RESULTS Our search strategy yielded 2214 articles published between 1960 and 2023. Nine systematic reviews fitted our inclusion criteria. Our umbrella review suggests that yoga is effective on positive and negative symptoms, and well-being, whereas aerobics is only effective on positive symptoms. We also found that supplementing polyunsaturated fatty acids and trace elements reduced schizophrenia's negative symptoms. CONCLUSION Our umbrella review highlighted moderate to low-quality evidence supporting the effectiveness of physical activity on negative and positive schizophrenia symptoms and the overall well-being of patients with schizophrenia. Our review findings support the need to promote physical activity and supplementation of micronutrients, a cost-effective strategy to promote healthy lifestyles in low and middle-income countries.
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Affiliation(s)
- Houda El Kirat
- Public Health and Management Department, International School of Public Health, Mohammed VI University of Health and Sciences, UM6SS, Casablanca, Morocco; Mohammed VI Center for Research and Innovation, CM6RI, Rabat, Morocco; National School of Public Health, Ministry of Health, and Social Protection, Morocco.
| | - Asmaa Khattabi
- Public Health and Management Department, International School of Public Health, Mohammed VI University of Health and Sciences, UM6SS, Casablanca, Morocco; Mohammed VI Center for Research and Innovation, CM6RI, Rabat, Morocco
| | - Mohamed Khalis
- Mohammed VI Center for Research and Innovation, CM6RI, Rabat, Morocco
| | - Zakaria Belrhiti
- Public Health and Management Department, International School of Public Health, Mohammed VI University of Health and Sciences, UM6SS, Casablanca, Morocco; Mohammed VI Center for Research and Innovation, CM6RI, Rabat, Morocco
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Graciani AL, Gutierre MU, Coppi AA, Arida RM, Gutierre RC. MYELIN, AGING, AND PHYSICAL EXERCISE. Neurobiol Aging 2023; 127:70-81. [PMID: 37116408 DOI: 10.1016/j.neurobiolaging.2023.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 04/03/2023]
Abstract
Myelin sheath is a structure in neurons fabricated by oligodendrocytes and Schwann cells responsible for increasing the efficiency of neural synapsis, impulse transmission, and providing metabolic support to the axon. They present morpho-functional changes during health aging as deformities of the sheath and its fragmentation, causing an increased load on microglial phagocytosis, with Alzheimer's disease aggravating. Physical exercise has been studied as a possible protective agent for the nervous system, offering benefits to neuroplasticity. In this regard, studies in animal models for Alzheimer's and depression reported the efficiency of physical exercise in protecting against myelin degeneration. A reduction of myelin damage during aging has also been observed in healthy humans. Physical activity promotes oligodendrocyte proliferation and myelin preservation during old age, although some controversies remain. In this review, we will address how effective physical exercise can be as a protective agent of the myelin sheath against the effects of aging in physiological and pathological conditions.
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BEATVIC, a body-oriented resilience therapy for individuals with psychosis: Short term results of a multi-center RCT. PLoS One 2022; 17:e0279185. [PMID: 36542671 PMCID: PMC9770373 DOI: 10.1371/journal.pone.0279185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Individuals with a psychotic disorder are at an increased risk of victimization, but evidenced-based interventions are lacking. AIMS A body-oriented resilience therapy ('BEATVIC') aimed at preventing victimization was developed and its effectiveness was assessed in a multicenter randomized controlled trial. METHODS 105 people with a psychotic disorder were recruited from six mental health centers. Participants were randomly allocated to 20 BEATVIC group sessions (n = 53) or befriending group sessions (n = 52). Short term effects on risk factors for victimization (e.g. social cognitive deficits, inadequate interpersonal behavior, low self-esteem, internalized stigma, aggression regulation problems), physical fitness and secondary outcomes were expected. At six-month follow-up, the effect on victimization (either a 50% reduction or an absence of victimization incidents) was examined. RESULTS Intervention-dropout was 28.30% for BEATVIC and 39.62% for befriending. In both conditions the majority of participants (60.5% BEATVIC vs 62.9% befriending) showed a reduction or absence of victimization incidents at six months follow-up, which was not significantly different according to condition. Multilevel analyses revealed no main effect of time and no significant time x group interaction on other outcome measures. Per protocol analyses (participants attending ≥ 75% of the sessions) did not change these results. CONCLUSIONS Although a reduction or absence of victimization was found at short term follow-up for the majority of participants, BEATVIC was not more effective than the active control condition. No short-term additional effects on risk factors of victimization were found. Analysis of the data at 2-year follow-up is warranted to investigate possible effects in the long-term. TRIAL REGISTRATION NUMBER Current Controlled Trials: ISRCTN21423535.
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Associations between aerobic fitness, negative symptoms, cognitive deficits and brain structure in schizophrenia—a cross-sectional study. SCHIZOPHRENIA 2022; 8:63. [PMID: 35918344 PMCID: PMC9345912 DOI: 10.1038/s41537-022-00269-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/12/2022] [Indexed: 11/21/2022]
Abstract
Negative symptoms and cognitive deficits are common in individuals with schizophrenia, greatly affect their outcome, and have been associated with alterations in cerebral gray and white matter volume (GMV, WMV). In the last decade, aerobic endurance training has emerged as a promising intervention to alleviate these symptoms and improved aerobic fitness has been suggested as a key moderator variable. In the present study, we investigated, whether aerobic fitness is associated with fewer cognitive deficits and negative symptoms and with GMVs and WMVs in individuals with schizophrenia in a cross-sectional design. In the largest study to date on the implications of fitness in individuals with schizophrenia, 111 participants at two centers underwent assessments of negative symptoms, cognitive functioning, and aerobic fitness and 69 underwent additional structural magnetic resonance imaging. Multilevel Bayesian partial correlations were computed to quantify relationships between the variables of interest. The main finding was a positive association of aerobic fitness with right hippocampal GMV and WMVs in parahippocampal and several cerebellar regions. We found limited evidence for an association of aerobic fitness with cognitive functioning and negative symptoms. In summary, our results strengthen the notion that aerobic fitness and hippocampal plasticity are interrelated which holds implications for the design of exercise interventions in individuals with schizophrenia.
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The Transtheoretical Model based psychoeducation's effect on healthy lifestyle behaviours in schizophrenia: A randomized controlled trial. Arch Psychiatr Nurs 2022; 41:51-61. [PMID: 36428075 DOI: 10.1016/j.apnu.2022.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 06/15/2022] [Accepted: 07/09/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The study was conducted with the pretest-posttest randomized controlled trial design to detect the psychoeducation's effect, based on the Transtheoretical Model, on the healthy lifestyle behaviours of individuals with schizophrenia. METHODS The data were collected from 82 participants, as 41 intervention and 41 control. The data were collected via personal information form, behavioural change stage diagnosis form and healthy lifestyle scale II. 6-week psychoeducation, consisting of 6 modules, based on the Transtheoretical Model, was applied to the intervention group. No interventions were applied to the control group. Pretests and posttests were applied to both groups. RESULTS When the healthy lifestyle scale II of intervention and control groups and final test results arranged according to ANCOVA analysis are compared, average final test results were meaningfully positive for the intervention group with taking control of the pretest and other covariants. When the pretest-posttest results in terms of behavioural change of the intervention group are evaluated; a meaningful difference among nutrition, physical exercises, spiritual self-improvement and stress management, which all are the stages of behavioural change, was detected. CONCLUSION It was determined that psychoeducation on a healthy lifestyle, based on the Transtheoretical Model in an individual with schizophrenia affected physical exercises, spiritual self-improvement and interpersonal relationships sub-dimension in medium level, and had a drastic influence on health responsibility, nutrition, stress management sub-dimensions and all healthy lifestyle behaviours. Progress in behavioural change stages was detected. CLINICAL TRIALS ID NCT05259748.
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Miskowiak KW, Seeberg I, Jensen MB, Balanzá‐Martínez V, del Mar Bonnin C, Bowie CR, Carvalho AF, Dols A, Douglas K, Gallagher P, Hasler G, Lafer B, Lewandowski KE, López‐Jaramillo C, Martinez‐Aran A, McIntyre RS, Porter RJ, Purdon SE, Schaffer A, Stokes P, Sumiyoshi T, Torres IJ, Van Rheenen TE, Yatham LN, Young AH, Kessing LV, Burdick KE, Vieta E. Randomised controlled cognition trials in remitted patients with mood disorders published between 2015 and 2021: A systematic review by the International Society for Bipolar Disorders Targeting Cognition Task Force. Bipolar Disord 2022; 24:354-374. [PMID: 35174594 PMCID: PMC9541874 DOI: 10.1111/bdi.13193] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cognitive impairments are an emerging treatment target in mood disorders, but currently there are no evidence-based pro-cognitive treatments indicated for patients in remission. With this systematic review of randomised controlled trials (RCTs), the International Society for Bipolar Disorders (ISBD) Targeting Cognition Task force provides an update of the most promising treatments and methodological recommendations. METHODS The review included RCTs of candidate pro-cognitive interventions in fully or partially remitted patients with major depressive disorder or bipolar disorder. We followed the procedures of the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) 2020 statement. Searches were conducted on PubMed/MEDLINE, PsycInfo, EMBASE and Cochrane Library from January 2015, when two prior systematic reviews were conducted, until February 2021. Two independent authors reviewed the studies with the Revised Cochrane Collaboration's Risk of Bias tool for Randomised trials. RESULTS We identified 16 RCTs (N = 859) investigating cognitive remediation (CR; k = 6; N = 311), direct current or repetitive magnetic stimulation (k = 3; N = 127), or pharmacological interventions (k = 7; N = 421). CR showed most consistent cognitive benefits, with two trials showing improvements on primary outcomes. Neuromodulatory interventions revealed no clear efficacy. Among pharmacological interventions, modafinil and lurasidone showed early positive results. Sources of bias included small samples, lack of pre-screening for objective cognitive impairment, no primary outcome and no information on allocation sequence masking. CONCLUSIONS Evidence for pro-cognitive treatments in mood disorders is emerging. Recommendations are to increase sample sizes, pre-screen for impairment in targeted domain(s), select one primary outcome, aid transfer to real-world functioning, investigate multimodal interventions and include neuroimaging.
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Affiliation(s)
- Kamilla W. Miskowiak
- Copenhagen Affective Disorder Research Centre (CADIC)Psychiatric Centre CopenhagenCopenhagen University HospitalCopenhagenDenmark,Department of PsychologyUniversity of CopenhagenCopenhagenDenmark
| | - Ida Seeberg
- Copenhagen Affective Disorder Research Centre (CADIC)Psychiatric Centre CopenhagenCopenhagen University HospitalCopenhagenDenmark,Department of PsychologyUniversity of CopenhagenCopenhagenDenmark
| | - Mette B. Jensen
- Copenhagen Affective Disorder Research Centre (CADIC)Psychiatric Centre CopenhagenCopenhagen University HospitalCopenhagenDenmark
| | - Vicent Balanzá‐Martínez
- Teaching Unit of Psychiatry and Psychological MedicineDepartment of MedicineUniversity of ValenciaCIBERSAMValenciaSpain
| | - Caterina del Mar Bonnin
- Clinical Institute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSCIBERSAMBarcelonaSpain
| | | | - Andre F. Carvalho
- IMPACT Strategic Research Centre (Innovation in Mental and Physical Health and Clinical Treatment)Deakin UniversityGeelongVic.Australia
| | - Annemieke Dols
- Department of Old Age PsychiatryGGZ in GeestAmsterdam UMC, Location VUmcAmsterdam NeuroscienceAmsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Katie Douglas
- Department of Psychological MedicineUniversity of OtagoChristchurchNew Zealand
| | - Peter Gallagher
- Translational and Clinical Research InstituteFaculty of Medical SciencesNewcastle UniversityNewcastle‐upon‐TyneUK
| | - Gregor Hasler
- Psychiatry Research UnitUniversity of FribourgFribourgSwitzerland
| | - Beny Lafer
- Bipolar Disorder Research ProgramInstitute of PsychiatryHospital das ClinicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrazil
| | - Kathryn E. Lewandowski
- McLean HospitalSchizophrenia and Bipolar Disorder ProgramBelmontMassachusettsUSA,Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
| | - Carlos López‐Jaramillo
- Research Group in PsychiatryDepartment of PsychiatryUniversidad de AntioquiaMedellínColombia
| | - Anabel Martinez‐Aran
- Clinical Institute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSCIBERSAMBarcelonaSpain
| | - Roger S. McIntyre
- Mood Disorders Psychopharmacology Unit, Brain and Cognition Discovery FoundationUniversity of TorontoTorontoCanada
| | - Richard J. Porter
- Department of Psychological MedicineUniversity of OtagoChristchurchNew Zealand
| | - Scot E. Purdon
- Department of PsychiatryUniversity of AlbertaEdmontonCanada
| | | | - Paul Stokes
- Department of Psychological MedicineInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Tomiki Sumiyoshi
- Department of Preventive Intervention for Psychiatric DisordersNational Institute of Mental HealthNational Center of Neurology and PsychiatryTokyoJapan
| | - Ivan J. Torres
- Department of PsychiatryUniversity of British ColumbiaVancouverCanada
| | - Tamsyn E. Van Rheenen
- Melbourne Neuropsychiatry CentreDepartment of PsychiatryUniversity of MelbourneCarltonAustralia,Centre for Mental HealthFaculty of Health, Arts and DesignSwinburne UniversityAustralia
| | - Lakshmi N. Yatham
- Department of PsychiatryUniversity of British ColumbiaVancouverCanada
| | - Allan H. Young
- Department of Psychological MedicineInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Lars V. Kessing
- Copenhagen Affective Disorder Research Centre (CADIC)Psychiatric Centre CopenhagenCopenhagen University HospitalCopenhagenDenmark,Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Katherine E. Burdick
- Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA,Department of PsychiatryBrigham and Women’s HospitalBostonMassachusettsUSA
| | - Eduard Vieta
- Clinical Institute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSCIBERSAMBarcelonaSpain
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Chen LJ, Stubbs B, Chien IC, Lan TH, Chung MS, Lee HL, Hsu WC, Ku PW. Associations between daily steps and cognitive function among inpatients with schizophrenia. BMC Psychiatry 2022; 22:87. [PMID: 35120468 PMCID: PMC8815184 DOI: 10.1186/s12888-022-03736-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 01/20/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Walking is the fundamental component of taking steps and is the main form of physical activity among individuals with schizophrenia; it also offers a range of health benefits. This study aimed to examine the associations between daily steps and cognitive function and further explored how many steps were related to better cognitive function among inpatients with schizophrenia. METHODS Inpatients with schizophrenia were recruited from long-stay psychiatric wards across two hospitals (n=199 at site 1 and n=195 at site 2). Daily steps were collected with an accelerometer for 7 days. Four cognitive domains (attention, processing speed, reaction time, and motor speed) were tested at site 1, and two cognitive domains (attention and processing speed) were tested at site 2. The associations of daily steps and levels of steps/day with cognitive function were tested using multivariable linear regressions separated by site. Covariates included demographic variables, weight status, metabolic parameters, and clinical state. RESULTS Participants took an average of 7445 (±3442) steps/day. More steps were related to better attention, processing speed, reaction time, and motor speed after multivariable adjustments. Compared with participants taking <5000 steps/day, those taking ≥5000 steps/day showed significantly better processing speed. Participants taking ≥7500 steps/day were associated with better attention, better reaction time, and better motor speed than those taking <5000 steps/day. CONCLUSION Daily steps are associated with better cognitive function among inpatients with schizophrenia. The optimal benefit for cognitive function among this clinical population is achieving 7500 steps/day or more.
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Affiliation(s)
- Li-Jung Chen
- grid.445057.7Department of Exercise Health Science, National Taiwan University of Sport, 271, Lixing Road, Taichung, 404 Taiwan
| | - Brendon Stubbs
- grid.37640.360000 0000 9439 0839Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ United Kingdom ,grid.13097.3c0000 0001 2322 6764Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom
| | - I-Chia Chien
- grid.454740.6Center for the Development of Teaching and Research, Bali Psychiatric Center, Ministry of Health and Welfare, 33, Huafushan Rd, Bali Distric, New Taipei City, 249 Taiwan
| | - Tsuo-Hung Lan
- grid.454740.6Tsaotun Psychiatric Center, Ministry of Health and Welfare, 161, Yu-Pin Rd, Nan-Tou County 542 Caotun Township, Taiwan ,grid.260539.b0000 0001 2059 7017Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan ,grid.59784.370000000406229172Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan ,grid.260539.b0000 0001 2059 7017Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Shun Chung
- grid.454740.6Jianan Psychiatric Center, Ministry of Health and Welfare, 80, Lane 870, Zhongshan Road, Tainan, 717 Taiwan
| | - Hui-Ling Lee
- grid.454740.6Tsaotun Psychiatric Center, Ministry of Health and Welfare, 161, Yu-Pin Rd, Nan-Tou County 542 Caotun Township, Taiwan
| | - Wan-Chi Hsu
- grid.454740.6Tsaotun Psychiatric Center, Ministry of Health and Welfare, 161, Yu-Pin Rd, Nan-Tou County 542 Caotun Township, Taiwan
| | - Po-Wen Ku
- Graduate Institute of Sports and Health Management, National Chung Hsing University, 145 Xingda Rd., South Dist, Taichung, 402, Taiwan.
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11
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Bang-Kittilsen G, Engh JA, Holst R, Holmen TL, Bigseth TT, Andersen E, Mordal J, Egeland J. High-intensity interval training may reduce depressive symptoms in individuals with schizophrenia, putatively through improved VO 2max: A randomized controlled trial. Front Psychiatry 2022; 13:921689. [PMID: 36003983 PMCID: PMC9394183 DOI: 10.3389/fpsyt.2022.921689] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 06/29/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION High-intensity interval training (HIIT) may improve cardiorespiratory fitness (CRF) and mental health. The current observer-blinded RCT investigates the sparsely studied efficiency of HIIT in reducing psychotic and non-psychotic symptoms in schizophrenia and complements previous studies by investigating whether symptom reduction following HIIT is associated with, putatively partly mediated by, increased VO2max. METHODS Participants (outpatients meeting diagnostic criteria for schizophrenia) were randomized to HIIT (n = 43) or a comparison group performing low-intensity active video gaming (AVG) to control for social interaction (n = 39). Both interventions consisted of two supervised sessions/week for 12 weeks and a 4 months follow-up. Effects on overall symptoms and symptom domains [PANSS (0-6 scale), five-factor model] were estimated using mixed-effects models (intention-to-treat, n = 82). Underlying mechanisms were analyzed using moderated mediation analyses (n = 66). We anticipated that HIIT would reduce overall symptoms, particularly depressive symptoms, more than AVG, and symptom reduction would be associated with, putatively mediated through, improved VO2max. RESULTS Depressive symptoms (baseline score 3.97, 95% CI: 3.41, 4.52), were -1.03 points more reduced in HIIT than AVG at post-intervention (95% CI: -1.71, -0.35, p = 0.003), corresponding to a small to moderate effect size (d = 0.37) and persisting at follow-up. There was a small reduction in overall symptoms, but no significant between-group differences were observed. Change in VO2max correlated negatively with the change in depressive symptoms. Mediation analysis showed a significant effect of change in VO2max on change in depressive symptoms within HIIT. The total effect was moderated by group, and depressive symptoms were more reduced in HIIT. Direct effects, not mediated through VO2max, were non-significant. Indirect effects, mediated through VO2max, were non-significant, but the moderated mediation test indicated a non-significant trend of 0.4 points (95% CI: -1.188, 0.087) and a larger reduction in depressive symptoms through VO2max in HIIT. CONCLUSION HIIT reduced depressive symptoms more than AVG, which persisted at follow-up. HIIT may serve as a complementing treatment option targeting these symptoms in individuals with schizophrenia, even before they reach clinical depression. Depressive symptoms are important to prevent, stabilize, and treat due to their negative implications for psychological wellbeing and long-term functional outcome. Reduction in depressive symptoms was associated with improved VO2max, and non-significant trends in the data supported that improved VO2max may be part of the complex mechanisms underlying the anti-depressive effect of HIIT. CLINICAL TRIAL REGISTRATION [www.ClinicalTrials.gov], identifier [NCT02205684].
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Affiliation(s)
- Gry Bang-Kittilsen
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
| | - John Abel Engh
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
| | - René Holst
- Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway
| | - Tom Langerud Holmen
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
| | | | - Eivind Andersen
- Faculty of Humanities, Sports and Educational Science, University of Southeast Norway, Horten, Norway
| | - Jon Mordal
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
| | - Jens Egeland
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
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12
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Şenormancı G, Korkmaz N, Şenormancı Ö, Uğur S, Topsaç M, Gültekin O. Effects of Exercise on Resilience, Insight and Functionality in Patients with Chronic Schizophrenia in a Psychiatric Nursing Home Setting: A Randomized Controlled Trial. Issues Ment Health Nurs 2021; 42:690-698. [PMID: 33275467 DOI: 10.1080/01612840.2020.1847221] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
To our knowledge, there are no studies on the effects of exercise in patients with severe schizophrenia-related disability or in nursing home settings. Again, the literature search on the influence of exercise on insight and resilience gives no results except mind-body exercises. The aim of this study was to investigate the effects of exercise on psychotic symptoms, depression, functionality, insight and resilience in patients with severe schizophrenia-related disability living in nursing home setting. Thirty-nine patients with schizophrenia were recruited. Exercise group with 20 patients who continued resistance exercise for 60 min, 2 days a week, for 3 months; and treatment as usual (TAU) group with 19 patients. All patients were administered Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms (SANS), Calgary Depression Scale for Schizophrenia (CDSS), Schedule for Assessment of Insight (SAI), Functional Remission of General Schizophrenia Scale (FROGS), Resilience Scale for Adults (RSA) at baseline and 3 months after. There were no significant differences between the groups for baseline and third month scores. In both groups significant decrease in SANS scores, significant increase in scores of FROGS total and social functioning, daily life skills subscale and RSA perception of the self were observed. In exercise group, significant decrease in CDSS scores, and significant increase in SAI awareness of illness, FROGS health and treatment, occupational functioning scores were found. Exercise combined with TAU may be effective in increasing awareness of illness and alleviating depression in chronic schizophrenia.
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Affiliation(s)
- Güliz Şenormancı
- Department of Psychiatry, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital , Bursa , Turkey
| | - Nimet Korkmaz
- Faculty of Sport Sciences Physical Education and Sports Teaching Department, Uludağ University , Bursa , Turkey
| | - Ömer Şenormancı
- Department of Psychiatry, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital , Bursa , Turkey
| | - Selen Uğur
- Faculty of Sport Sciences Physical Education and Sports Teaching Department, Uludağ University , Bursa , Turkey
| | - Mine Topsaç
- Faculty of Sport Sciences Physical Education and Sports Teaching Department, Uludağ University , Bursa , Turkey
| | - Okan Gültekin
- Faculty of Sport Sciences Physical Education and Sports Teaching Department, Uludağ University , Bursa , Turkey
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13
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Bang-Kittilsen G, Egeland J, Holmen TL, Bigseth TT, Andersen E, Mordal J, Ulleberg P, Engh JA. High-intensity interval training and active video gaming improve neurocognition in schizophrenia: a randomized controlled trial. Eur Arch Psychiatry Clin Neurosci 2021; 271:339-353. [PMID: 33156372 DOI: 10.1007/s00406-020-01200-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 10/14/2020] [Indexed: 12/11/2022]
Abstract
There is a need for treatments targeting neurocognitive dysfunctions in schizophrenia. The aim of this study was to investigate the neurocognitive effect of aerobic high-intensity interval training (HIIT). A comparison group performed sport simulating active video gaming (AVG). We anticipated that HIIT would improve neurocognition beyond any effect of AVG, due to engagement in higher intensity cardiorespiratory demands. Recent research on the beneficial neurocognitive effect of AVG challenges this expectation but added new relevance to comparing the two interventions. This is an observer-blinded randomized controlled trial. Eighty-two outpatients diagnosed with schizophrenia were allocated to HIIT (n = 43) or AVG (n = 39). Both groups received two supervised sessions per week for 12 weeks. The attrition rate was 31%, and 65% of the participants were defined as protocol compliant study completers. Intention-to-treat analyses showed significant improvements in the neurocognitive composite score from baseline to post-intervention and from baseline to 4 months follow-up in the total sample. The same pattern of results was found in several subdomains. Contrary to our hypothesis, we found no interaction effects of time and group, indicating equal effects in both groups. Separate within-group analysis unexpectedly showed trends of differential effects in the learning domain, as HIIT showed post-intervention improvement in verbal but not visual learning, while AVG showed improvement in visual but not verbal learning. HIIT and AVG improve neurocognition equally, suggesting that both interventions may be applied to target neurocognition in schizophrenia. Future research should investigate trends towards possible differential effects of exercise modes on neurocognitive subdomains. NCT02205684, 31.07.14.
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Affiliation(s)
- Gry Bang-Kittilsen
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Mail Office Box 2168, 3103, Tønsberg, Norway.
| | - Jens Egeland
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Mail Office Box 2168, 3103, Tønsberg, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Tom Langerud Holmen
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Mail Office Box 2168, 3103, Tønsberg, Norway
| | - Therese Torgersen Bigseth
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Mail Office Box 2168, 3103, Tønsberg, Norway
| | - Eivind Andersen
- Faculty of Humanities, Sports and Educational Science, University of Southeast Norway, Horten, Norway
| | - Jon Mordal
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Mail Office Box 2168, 3103, Tønsberg, Norway
| | - Pål Ulleberg
- Department of Psychology, University of Oslo, Oslo, Norway
| | - John Abel Engh
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Mail Office Box 2168, 3103, Tønsberg, Norway
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14
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Maurus I, Hasan A, Schmitt A, Roeh A, Keeser D, Malchow B, Schneider-Axmann T, Hellmich M, Schmied S, Lembeck M, Keller-Varady K, Papazova I, Hirjak D, Topor CE, Walter H, Mohnke S, Vogel BO, Wölwer W, Schneider F, Henkel K, Meyer-Lindenberg A, Falkai P. Aerobic endurance training to improve cognition and enhance recovery in schizophrenia: design and methodology of a multicenter randomized controlled trial. Eur Arch Psychiatry Clin Neurosci 2021; 271:315-324. [PMID: 32748261 PMCID: PMC8257533 DOI: 10.1007/s00406-020-01175-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 07/22/2020] [Indexed: 12/20/2022]
Abstract
Even today, patients with schizophrenia often have an unfavorable outcome. Negative symptoms and cognitive deficits are common features in many patients and prevent recovery. In recent years, aerobic endurance training has emerged as a therapeutic approach with positive effects on several domains of patients' health. However, appropriately sized, multicenter randomized controlled trials that would allow better generalization of results are lacking. The exercise study presented here is a multicenter, rater-blind, two-armed, parallel-group randomized clinical trial in patients with clinically stable schizophrenia being conducted at five German tertiary hospitals. The intervention group performs aerobic endurance training on bicycle ergometers three times per week for 40-50 min/session (depending on the intervention week) for a total of 26 weeks, and the control group performs balance and tone training for the same amount of time. Participants are subsequently followed up for 26 weeks. The primary endpoint is all-cause discontinuation; secondary endpoints include psychopathology, cognition, daily functioning, cardiovascular risk factors, and explorative biological measures regarding the underlying mechanisms of exercise. A total of 180 patients will be randomized. With currently 162 randomized participants, our study is the largest trial to date to investigate endurance training in patients with schizophrenia. We hypothesize that aerobic endurance training has beneficial effects on patients' mental and physical health, leading to lower treatment discontinuation rates and improving disease outcomes. The study results will provide a basis for recommending exercise interventions as an add-on therapy in patients with schizophrenia.The study is registered in the International Clinical Trials Database (ClinicalTrials.gov identifier [NCT number]: NCT03466112) and in the German Clinical Trials Register (DRKS-ID: DRKS00009804).
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Affiliation(s)
- Isabel Maurus
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany.
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
- Department of Psychiatry and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, University of Augsburg, Augsburg, Germany
| | - Andrea Schmitt
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
- Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of Sao Paulo, São Paulo, Brazil
| | - Astrid Roeh
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, University Hospital Göttingen, Göttingen, Germany
| | - Thomas Schneider-Axmann
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Martin Hellmich
- Faculty of Medicine, Institute of Medical Statistics and Computational Biology, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sabine Schmied
- Faculty of Medicine, Clinical Trials Centre Cologne, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Moritz Lembeck
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
| | | | - Irina Papazova
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Dusan Hirjak
- Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Cristina E Topor
- Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Mohnke
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Bob O Vogel
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany
| | - Frank Schneider
- University Hospital, Heinrich-Heine University, Düsseldorf, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH, Aachen, Germany
| | - Karsten Henkel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH, Aachen, Germany
| | - Andreas Meyer-Lindenberg
- Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
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15
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Chen C, Yang Y, Ye X, Jin Y, Cai Z, Zheng J. Impact of aerobic exercise on cognitive function in patients with schizophrenia during daily nursing: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e23876. [PMID: 33429747 PMCID: PMC7793402 DOI: 10.1097/md.0000000000023876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To assess the effect of aerobic exercise (AE) on cognition function in people with schizophrenia (SZ) during daily nursing. METHODS The literature search will be conducted via PubMed, Embase, Cochrane Library, and Web of Science. Weighted mean difference (WMD) or standardized mean difference (SMD) and 95% confidence intervals (CIs) will be adopted to calculate the association between AE and cognitive function in patients with SZ. Publication bias will be performed by Begg test. When there is publication bias, "cut-and-fill method" will be adopted to adjust publication bias. Sensitivity analysis will be used to test the stability of the result. When the heterogeneity is large (I2 ≥ 50%), meta regression will be used to explore the source of inter-study heterogeneity. When the heterogeneity is large (I2 ≥ 50%) and the results are statistically significant (P < .05), age, sex, duration of disease, duration of intervention, amount of exercise per week, improvement of cardiopulmonary health, and other factors will be sub-analyzed. CONCLUSION This meta-analysis will evaluate the impact of aerobic exercise on cognitive function in patients with SZ during daily nursing on the basis of existing evidence. OSF REGISTRATION NUMBER 10.17605/OSF.IO/C8ABX.
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Affiliation(s)
| | | | | | | | - Ziyao Cai
- Department of Outpatient, Wenzhou Seventh People's Hospital, Wenzhou, P.R. China
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16
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[Implementation of exercise therapy in daily clinical practice in psychiatric clinics in Germany]. DER NERVENARZT 2020; 91:642-650. [PMID: 31463534 DOI: 10.1007/s00115-019-0782-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Exercise therapy has proven to be effective in the treatment of multiple mental illnesses. As mental disorders result in tremendous costs for the healthcare system as well as a huge burden for the affected individuals, improving treatment strategies according to latest scientific evidence should be of highest priority. In 2016 a first study provided indications that only a minority of patients are treated with exercise therapy during their stay in hospital. Hence, the aim of this study was to assess the actual extent of exercise therapy usage in psychiatric inpatients in Germany, thereby giving a scientific foundation to the call for a better standard of care. To achieve this, a retrospective analysis was performed on pre-existing data from 2693 patients who were treated in 1 of 4 participating university hospitals. Only 23% of these patients participated in exercise therapy with a mean training duration of 36 min per week. Patients with the diagnosis of schizophrenia or patients with multiple comorbidities were even less likely to participate in exercise therapy. With these findings it becomes evident that the healthcare situation concerning exercise therapy is insufficient. Solid evidence for the effectiveness of exercise therapy, the current treatment guidelines as well as the positive side effects, especially when compared to side effects of pharmacotherapy (i.e. weight gain) should motivate healthcare officials to make an effort to improve this situation.
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17
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Kern RS, Reddy LF, Cohen AN, Young AS, Green MF. Effects of aerobic exercise on cardiorespiratory fitness and social functioning in veterans 40 to 65 years old with schizophrenia. Psychiatry Res 2020; 291:113258. [PMID: 32763533 DOI: 10.1016/j.psychres.2020.113258] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 11/26/2022]
Abstract
The usual physical activity level of people with chronic histories of schizophrenia is very low. In this pilot study, we examined the effects of an easy to implement aerobic exercise (AE) program on cardiorespiratory fitness and social functioning in 54 Veterans aged 40-65 years old with schizophrenia. Participants were randomized 2:1 to AE (36 forty-minute sessions conducted 3 times per week over 12 weeks) versus a non-aerobic stretching exercise condition conducted under the same regimen and timeframe. Cardiorespiratory fitness improved significantly within the AE group (p<.0001), and differed significantly from the comparison group (p<.02; Cohen's d=.41). Trend-level improvements were seen in social functioning within the AE group (p<.09) and showed a similar trend level difference in the between-group comparison (p<.06; Cohen's d=.35). Improvements in social functioning were significantly related to gains in cardiorespiratory fitness (r=.42; p<.01). AE effects on other physical and mental health indices were also examined. Overall, the AE intervention was well-tolerated, safe, and showed low rates of attrition after the commencement of training. Our findings indicate it is feasible to improve cardiorespiratory fitness in this clinical population, and there is suggestive evidence that the interventions aimed to do so may also benefit social functioning.
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Affiliation(s)
- Robert S Kern
- UCLA Semel Institute for Neuroscience & Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, California, United States of America; Department of Veterans Affairs Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, United States of America.
| | - L Felice Reddy
- UCLA Semel Institute for Neuroscience & Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, California, United States of America
| | - Amy N Cohen
- UCLA Semel Institute for Neuroscience & Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, California, United States of America; Department of Veterans Affairs Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, United States of America
| | - Alexander S Young
- UCLA Semel Institute for Neuroscience & Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, California, United States of America; Department of Veterans Affairs Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, United States of America
| | - Michael F Green
- UCLA Semel Institute for Neuroscience & Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, California, United States of America; Department of Veterans Affairs Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, United States of America
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18
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Takahashi S, Keeser D, Rauchmann BS, Schneider-Axmann T, Keller-Varady K, Maurus I, Dechent P, Wobrock T, Hasan A, Schmitt A, Ertl-Wagner B, Malchow B, Falkai P. Effect of aerobic exercise combined with cognitive remediation on cortical thickness and prediction of social adaptation in patients with schizophrenia. Schizophr Res 2020; 216:397-407. [PMID: 31806522 DOI: 10.1016/j.schres.2019.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 07/29/2019] [Accepted: 11/03/2019] [Indexed: 01/09/2023]
Abstract
Aerobic exercise is a promising intervention for patients with schizophrenia, but structural neuroplastic effects on brain regions relevant to the pathophysiology of the disease remain unclear. This study aimed to elucidate longitudinal changes in cortical thickness after aerobic exercise intervention in schizophrenia patients and the relationship of these changes to clinical correlates. We investigated 21 schizophrenia patients and 23 healthy controls who performed aerobic exercise and 21 schizophrenia patients who played table soccer. The 12-week exercise intervention was combined with computer-assisted cognitive remediation training from week 6 to week 12. Magnetic resonance imaging (MRI) scans were acquired at baseline and weeks 6, 12, and 24. The thickness of the entorhinal, parahippocampal, and lateral and medial prefrontal cortices was assessed with FreeSurfer 6.0. The schizophrenia aerobic exercise group showed a significant increase of cortical thickness in the right entorhinal cortex at week 6, and we found a significant correlation between the cortical thickness of the right lateral prefrontal cortex at baseline and improvement of social adaptation at week 12. In the schizophrenia table soccer and healthy control groups, we found no significant longitudinal change in cortical thickness through the intervention and follow-up period and no correlation of cortical thickness at baseline with clinical measures. Our results suggest that aerobic exercise in schizophrenia modulates the thickness of the entorhinal cortex, a structure adjacent to the hippocampus. Greater cortical thickness of the right lateral prefrontal cortex appears to predict better clinical response to an aerobic exercise intervention in patients with schizophrenia.
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Affiliation(s)
- Shun Takahashi
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany; Department of Neuropsychiatry, Wakayama Medical University, 811-1 Kimiidera, 6410012, Wakayama, Japan.
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany; Department of Radiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Boris-Stephan Rauchmann
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany; Department of Radiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Thomas Schneider-Axmann
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - Katriona Keller-Varady
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - Isabel Maurus
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - Peter Dechent
- Institute for Cognitive Neurology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Thomas Wobrock
- Department of Psychiatry and Psychotherapy, Georg-August-University, Von-Siebold-Str. 5, 37075, Göttingen, Germany; Centre of Mental Health, County Hospitals Darmstadt-Dieburg, Krankenhausstraße 7, 64823, Groß-Umstadt, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - Andrea Schmitt
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany; Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of Sao Paulo, 05403-010, São Paulo, Brazil
| | - Birgit Ertl-Wagner
- Department of Radiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany; Department of Medical Imaging, University of Toronto, McCaul Street 263, Toronto, M5T1W7, Ontario, Canada
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany; Department of Psychiatry and Psychotherapy, University of Jena, Philosophenweg 3, 07743, Jena, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
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19
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Maurus I, Mantel C, Keller-Varady K, Schmitt A, Lembeck M, Röh A, Papazova I, Falkai P, Schneider-Axmann T, Hasan A, Malchow B. Resistance training in patients with schizophrenia: Concept and proof of principle trial. J Psychiatr Res 2020; 120:72-82. [PMID: 31634752 DOI: 10.1016/j.jpsychires.2019.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/20/2019] [Accepted: 09/25/2019] [Indexed: 12/16/2022]
Abstract
Resistance training has been shown to contribute to the prevention and management of cardiovascular diseases, which is why it can help reducing morbidity and mortality in schizophrenia patients. Moreover, positive effects on different schizophrenia symptom domains have been proposed. However, a specific resistance training tailored to the needs of schizophrenia patients and its evaluation is still lacking. The objective in this proof of principle trial was to evaluate the feasibility and efficacy of a newly developed 12-week resistance program according to current recommendations of the WHO and the American College of Sports Medicine. We employed a single blind, parallel assignment clinical trial design with participants randomized to attend either a resistance training including three 50min units per week or a balance and tone program as control condition. The primary outcome was the impact on health-related difficulties assessed with the World Health Organization Disability Assessment Schedule (WHO-DAS). Secondary outcome parameters included the level of functioning, schizophrenia symptoms, selected cognitive parameters as well as risk factors for cardiovascular diseases. In our proof of principle trial, we could not find significant time or group effects of resistance training on the WHO-DAS. However, we could observe significant positive effects on the level of functioning assessed with the Global Assessment of Functioning Scale (GAF) over the course of time, which were more pronounced in the intervention group. Our findings indicated that patients with schizophrenia could safely participate in resistance training with relevant improvements in their level of functioning. Well-powered replication trials are needed to provide more efficacy data.
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Affiliation(s)
- I Maurus
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.
| | - C Mantel
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - K Keller-Varady
- Hannover Medical School, Institute of Sports Medicine, Hannover, Germany
| | - A Schmitt
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of Sao Paulo, São Paulo, Brazil
| | - M Lembeck
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - A Röh
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - I Papazova
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - P Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - T Schneider-Axmann
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - A Hasan
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - B Malchow
- Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany
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20
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Choi J, Taylor B, Fiszdon JM, Kurtz MM, Tek C, Dewberry MJ, Haber LC, Shagan D, Assaf M, Pearlson GD. The synergistic benefits of physical and cognitive exercise in schizophrenia: Promoting motivation to enhance community effectiveness. SCHIZOPHRENIA RESEARCH-COGNITION 2019; 19:100147. [PMID: 31828021 PMCID: PMC6889253 DOI: 10.1016/j.scog.2019.100147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/18/2019] [Accepted: 04/17/2019] [Indexed: 11/16/2022]
Abstract
Emerging research highlights the potential cognitive benefits of physical exercise (PE) programs for schizophrenia (SCZ). The few recent efficacy studies that examined augmenting cognitive training (CT) with PE suggest superior effects of the combination. The next step is to consider strategies to enhance adherence in real-world settings if this type of combined treatment is going to be effective. We present the first community effectiveness data for PE and CT that included a motivationally-enhancing, self-determined approach to exercise, in lieu of participant payment. Eighty-five outpatients with schizophrenia attending an intensive outpatient program were randomized to 18 h of either (A) self-determined PE regimen with choice from a menu of different activities; (B) tablet-based neurofeedback CT focused on processing speed (PS) and working memory (WM), or (C) a time-matched combination of PE and CT. Assessments were conducted at baseline, post, and follow-up (2 mo). All groups improved in WM from baseline to post, with greatest gains in the PE only group. At follow-up, cognitive gains originally observed in the PE-only group disappeared, while the PE + CT group evidenced improvements in WM and psychotic symptoms. Notably, attrition for PE was only 7%. Our data shows that combining PE and CT leads to lasting effects that are superior to those of either intervention alone. The low PE drop-out rate suggests a self-determined approach to the exercise regimen was tolerable, and may be an important component of future community implementation efforts.
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Affiliation(s)
- Jimmy Choi
- The Institute of Living at Hartford Hospital, 200 Retreat Ave, Hartford, CT 06106, United States of America
| | - Beth Taylor
- UCONN Institute for Collaboration on Health, Intervention and Policy, Storrs, CT, United States of America
| | - Joanna M Fiszdon
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America.,Psychology Service, VA Connecticut Healthcare System, West Haven, CT, United States of America
| | - Matthew M Kurtz
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America.,Department of Psychology and Neuroscience, Wesleyan University, Middletown, CT, United States of America
| | - Cenk Tek
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America
| | | | - Lawrence C Haber
- The Institute of Living at Hartford Hospital, 200 Retreat Ave, Hartford, CT 06106, United States of America
| | - Dana Shagan
- The Institute of Living at Hartford Hospital, 200 Retreat Ave, Hartford, CT 06106, United States of America
| | - Michal Assaf
- The Institute of Living at Hartford Hospital, 200 Retreat Ave, Hartford, CT 06106, United States of America.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America
| | - Godfrey D Pearlson
- The Institute of Living at Hartford Hospital, 200 Retreat Ave, Hartford, CT 06106, United States of America.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America
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21
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Papiol S, Keeser D, Hasan A, Schneider-Axmann T, Raabe F, Degenhardt F, Rossner MJ, Bickeböller H, Cantuti-Castelvetri L, Simons M, Wobrock T, Schmitt A, Malchow B, Falkai P. Polygenic burden associated to oligodendrocyte precursor cells and radial glia influences the hippocampal volume changes induced by aerobic exercise in schizophrenia patients. Transl Psychiatry 2019; 9:284. [PMID: 31712617 PMCID: PMC6848123 DOI: 10.1038/s41398-019-0618-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/10/2019] [Accepted: 10/03/2019] [Indexed: 02/04/2023] Open
Abstract
Hippocampal volume decrease is a structural hallmark of schizophrenia (SCZ), and convergent evidence from postmortem and imaging studies suggests that it may be explained by changes in the cytoarchitecture of the cornu ammonis 4 (CA4) and dentate gyrus (DG) subfields. Increasing evidence indicates that aerobic exercise increases hippocampal volume in CA subfields and improves cognition in SCZ patients. Previous studies showed that the effects of exercise on the hippocampus might be connected to the polygenic burden of SCZ risk variants. However, little is known about cell type-specific genetic contributions to these structural changes. In this secondary analysis, we evaluated the modulatory role of cell type-specific SCZ polygenic risk scores (PRS) on volume changes in the CA1, CA2/3, and CA4/DG subfields over time. We studied 20 multi-episode SCZ patients and 23 healthy controls who performed aerobic exercise, and 21 multi-episode SCZ patients allocated to a control intervention (table soccer) for 3 months. Magnetic resonance imaging-based assessments were performed with FreeSurfer at baseline and after 3 months. The analyses showed that the polygenic burden associated with oligodendrocyte precursor cells (OPC) and radial glia (RG) significantly influenced the volume changes between baseline and 3 months in the CA4/DG subfield in SCZ patients performing aerobic exercise. A higher OPC- or RG-associated genetic risk burden was associated with a less pronounced volume increase or even a decrease in CA4/DG during the exercise intervention. We hypothesize that SCZ cell type-specific polygenic risk modulates the aerobic exercise-induced neuroplastic processes in the hippocampus.
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Affiliation(s)
- Sergi Papiol
- Department of Psychiatry, University Hospital, Nussbaumstrasse 7, 80336, Munich, Germany. .,Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, Ludwig Maximilian University, Nussbaumstrasse 7, 80336, Munich, Germany.
| | - Daniel Keeser
- 0000 0004 0477 2585grid.411095.8Department of Psychiatry, University Hospital, Nussbaumstrasse 7, 80336 Munich, Germany ,0000 0004 1936 973Xgrid.5252.0Institute of Clinical Radiology, Ludwig Maximilian University Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Alkomiet Hasan
- 0000 0004 0477 2585grid.411095.8Department of Psychiatry, University Hospital, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Thomas Schneider-Axmann
- 0000 0004 0477 2585grid.411095.8Department of Psychiatry, University Hospital, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Florian Raabe
- 0000 0004 0477 2585grid.411095.8Department of Psychiatry, University Hospital, Nussbaumstrasse 7, 80336 Munich, Germany ,International Max Planck Research School for Translational Psychiatry, Kraepelinstr. 2-10, 80804 Munich, Germany
| | - Franziska Degenhardt
- 0000 0001 2240 3300grid.10388.32Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Moritz J. Rossner
- 0000 0004 0477 2585grid.411095.8Department of Psychiatry, University Hospital, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Heike Bickeböller
- Department of Genetic Epidemiology, University Medical Center, Georg-August-Universität Göttingen, Humboldtallee 32, 37073 Göttingen, Germany
| | - Ludovico Cantuti-Castelvetri
- 0000 0004 0438 0426grid.424247.3German Center for Neurodegenerative Diseases (DZNE), Feodor-Lynen Str. 17, 81377 Munich, Germany
| | - Mikael Simons
- 0000 0004 0438 0426grid.424247.3German Center for Neurodegenerative Diseases (DZNE), Feodor-Lynen Str. 17, 81377 Munich, Germany ,grid.452617.3Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany ,0000000123222966grid.6936.aInstitute of Neuronal Cell Biology, Technical University Munich, 80805 Munich, Germany
| | - Thomas Wobrock
- Department of Psychiatry and Psychotherapy, County Hospitals Darmstadt-Dieburg, Krankenhausstrasse 7, 64823 Groß-Umstadt, Germany
| | - Andrea Schmitt
- 0000 0004 0477 2585grid.411095.8Department of Psychiatry, University Hospital, Nussbaumstrasse 7, 80336 Munich, Germany ,0000 0004 1937 0722grid.11899.38Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of Sao Paulo, Rua Dr. Ovídio Pires de Campos 785, Sao Paulo-SP, 05403-903 Brazil
| | - Berend Malchow
- 0000 0004 0477 2585grid.411095.8Department of Psychiatry, University Hospital, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Peter Falkai
- 0000 0004 0477 2585grid.411095.8Department of Psychiatry, University Hospital, Nussbaumstrasse 7, 80336 Munich, Germany
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22
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Rassovsky Y, Harwood A, Zagoory-Sharon O, Feldman R. Martial arts increase oxytocin production. Sci Rep 2019; 9:12980. [PMID: 31506582 PMCID: PMC6736948 DOI: 10.1038/s41598-019-49620-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 08/28/2019] [Indexed: 01/01/2023] Open
Abstract
Numerous studies have demonstrated that oxytocin (OT), a peptide hormone, plays an important role in regulating mammalian social behaviors, linking it to social affiliation in parent-infant attachment, romantic and filial relationships, and other prosocial behaviors, such as trust and cooperation. Not surprisingly, research efforts have been made to increase endogenous levels of OT. In the present study, we investigated whether traditional martial arts training, which integrates the natural benefits of physical exercise with dyadic prosocial interaction, would result in OT response. To this end, 68 beginner and advanced participants were recruited from several schools practicing Jujitsu ("soft art"), a form of traditional martial arts originating in Japan. Salivary OT levels were assessed at baseline, immediately following high-intensity training, and following a cool-down period. Analyses revealed a significant increase in OT immediately after a high-intensity training, returning to baseline levels following a cool-down period. Additionally, although no significant difference between beginner and advanced martial artists was found, a significantly higher increase in salivary OT followed ground grappling, as compared to "punch-kick" sparring, indicating an added benefit of close contact tactile interaction. These results suggest that the reportedly socially beneficial effects of traditional martial arts may be in part mediated by OT release and underscore the potentially therapeutic applications of these methods for disorders involving social dysfunction, such as autism, conduct problems, or schizophrenia.
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Affiliation(s)
- Yuri Rassovsky
- Department of Psychology and Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel. .,Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA.
| | - Anna Harwood
- Department of Psychology and Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel
| | - Orna Zagoory-Sharon
- Center for Developmental, Social, and Relationship Neuroscience, Interdisciplinary Center, Herzliya, Israel
| | - Ruth Feldman
- Center for Developmental, Social, and Relationship Neuroscience, Interdisciplinary Center, Herzliya, Israel
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23
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Buschert V, Prochazka D, Bartl H, Diemer J, Malchow B, Zwanzger P, Brunnauer A. Effects of physical activity on cognitive performance: a controlled clinical study in depressive patients. Eur Arch Psychiatry Clin Neurosci 2019; 269:555-563. [PMID: 29951850 DOI: 10.1007/s00406-018-0916-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 05/22/2018] [Indexed: 11/29/2022]
Abstract
Physical activity is a common adjunctive therapy in psychiatric and psychosomatic hospitals. In the present study, we assessed the effects of an exercise program, integrated into routine inpatient treatment, on cognitive performance and subjective severity of depression in a sample of patients suffering from major depression. We randomized n = 38 patients with unipolar depression to either physical exercise (n = 18) or occupational therapy as an active control treatment (n = 20). Both treatments were delivered in group format over a period of 3-4 weeks. Data indicate that there were significant improvements of cognitive functions and depressive symptoms in both groups, with specific treatment effects in reaction time and in short-term verbal memory favoring the physical activity group. In conclusion, we found physical exercise to be a feasible, easy-to-implement add-on therapy for depressive patients with promising effects on cognitive performance. However, these results need to be replicated in larger samples with an extended follow-up.
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Affiliation(s)
- V Buschert
- Department of Neuropsychology, kbo-Inn-Salzach-Klinikum, Psychiatric Hospital, Gabersee 13, 83512, Wasserburg am Inn, Germany
| | - D Prochazka
- Department of Neuropsychology, kbo-Inn-Salzach-Klinikum, Psychiatric Hospital, Gabersee 13, 83512, Wasserburg am Inn, Germany
| | - H Bartl
- Department of Neuropsychology, kbo-Inn-Salzach-Klinikum, Psychiatric Hospital, Gabersee 13, 83512, Wasserburg am Inn, Germany
| | - J Diemer
- Department of Neuropsychology, kbo-Inn-Salzach-Klinikum, Psychiatric Hospital, Gabersee 13, 83512, Wasserburg am Inn, Germany
| | - B Malchow
- Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany.,Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University Munich, Munich, Germany
| | - P Zwanzger
- Department of Neuropsychology, kbo-Inn-Salzach-Klinikum, Psychiatric Hospital, Gabersee 13, 83512, Wasserburg am Inn, Germany.,Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University Munich, Munich, Germany
| | - A Brunnauer
- Department of Neuropsychology, kbo-Inn-Salzach-Klinikum, Psychiatric Hospital, Gabersee 13, 83512, Wasserburg am Inn, Germany. .,Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University Munich, Munich, Germany.
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24
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Maurus I, Hasan A, Röh A, Takahashi S, Rauchmann B, Keeser D, Malchow B, Schmitt A, Falkai P. Neurobiological effects of aerobic exercise, with a focus on patients with schizophrenia. Eur Arch Psychiatry Clin Neurosci 2019; 269:499-515. [PMID: 31115660 DOI: 10.1007/s00406-019-01025-w] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 05/15/2019] [Indexed: 02/08/2023]
Abstract
Schizophrenia is a severe neuropsychiatric disease that is associated with neurobiological alterations in multiple brain regions and peripheral organs. Negative symptoms and cognitive deficits are present in about half of patients and are difficult to treat, leading to an unfavorable functional outcome. To investigate the impact of aerobic exercise on various neurobiological parameters, we conducted a narrative review. Add-on aerobic exercise was shown to be effective in improving negative and general symptoms, cognition, global functioning, and quality of life in schizophrenia patients. Based on findings in healthy individuals and animal models, this qualitative review gives an overview of different lines of evidence on how aerobic exercise impacts brain structure and function and molecular mechanisms in patients with schizophrenia and how its effects could be related to clinical and functional outcomes. Structural magnetic resonance imaging studies showed a volume increase in the hippocampus and cortical regions in schizophrenia patients and healthy controls after endurance training. However, results are inconsistent and individual risk factors may influence neuroplastic processes. Animal studies indicate that alterations in epigenetic mechanisms and synaptic plasticity are possible underlying mechanisms, but that differentiation of glial cells, angiogenesis, and possibly neurogenesis may also be involved. Clinical and animal studies also revealed effects of aerobic exercise on the hypothalamus-pituitary-adrenal axis, growth factors, and immune-related mechanisms. Some findings indicate effects on neurotransmitters and the endocannabinoid system. Further research is required to clarify how individual risk factors in schizophrenia patients mediate or moderate the neurobiological effects of exercise on brain and cognition. Altogether, aerobic exercise is a promising candidate in the search for pathophysiology-based add-on interventions in schizophrenia.
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Affiliation(s)
- Isabel Maurus
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany.
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Astrid Röh
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Shun Takahashi
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany.,Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
| | - Boris Rauchmann
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany.,Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany
| | - Andrea Schmitt
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany.,Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of Sao Paulo, São Paulo, Brazil
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
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25
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Segal-Gavish H, Barzilay R, Rimoni O, Offen D. Voluntary exercise improves cognitive deficits in female dominant-negative DISC1 transgenic mouse model of neuropsychiatric disorders. World J Biol Psychiatry 2019; 20:243-252. [PMID: 28593819 DOI: 10.1080/15622975.2017.1323118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Physical exercise has gained increasing interest as a treatment modality that improves prognosis in psychiatric patients. The disrupted in schizophrenia 1 (DISC1) gene is a candidate gene for major mental illness. In this study, we aimed to determine whether voluntary wheel running can improve cognitive deficits of dominant-negative DISC1 transgenic mice (DN-DISC1). METHODS DN-DISC1 and control mice (10-week-old male and female) were placed for 14 days in a cage with or without access to a running wheel. Two weeks later, mice underwent behavioural tests evaluating cognition and social approach and recognition. RESULTS Voluntary exercise improved performance in the novel object recognition test, restored the impairment in spatial memory in the Y maze, and reversed the deficit in social recognition memory in DN-DISC1 females. DN-DISC1 males did not exhibit behavioural deficits at baseline. Tissue analysis revealed that exercise induced a significant increase in hippocampal expression of doublecortin (DCX), brain-derived neurotrophic factor (BDNF) and cannabinoid receptor type 1 (CB1R) only in DN-DISC1 females. CONCLUSIONS Voluntary exercise is beneficial in attenuating cognitive deficits observed in a rodent model relevant for neuropsychiatric disorders. The data add a preclinical aspect to the accumulating clinical data supporting the incorporation of physical exercise to patients' care.
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Affiliation(s)
- Hadar Segal-Gavish
- a Laboratory of Neuroscience , Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Ran Barzilay
- a Laboratory of Neuroscience , Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel.,b Research Unit , Geha Mental Health Center , Petach Tikva , Israel
| | - Ofri Rimoni
- a Laboratory of Neuroscience , Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Daniel Offen
- a Laboratory of Neuroscience , Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
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26
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Lambden B, Berge J, Forsell Y. Structured physical exercise and recovery from first episode psychosis in young adults, the FitForLife study. Psychiatry Res 2018; 267:346-353. [PMID: 29957552 DOI: 10.1016/j.psychres.2018.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/11/2018] [Accepted: 06/02/2018] [Indexed: 01/06/2023]
Abstract
Optimising autonomy is increasingly important in recovery from psychosis. To date, physical exercise has shown promise in the treatment of severe, enduring mental illnesses including psychosis - when used as an adjunct treatment. To assess the association between physical exercise and autonomy in young adults, a simple pre-post experimental design was utilised. Individuals aged 18-35 years, treated at one of three specialist outpatient units for first-episode psychosis in Stockholm, Sweden were invited to participate in a 12-week programme of structured group exercise. Autonomy was measured using four questions from the Camberwell Assessment of Needs questionnaire (physical health, social and close relationship and daily tasks). Comparisons were made between: 'no attendance' and 'any attendance'. The latter group was bisected into higher and lower categories. Ninety-four participants enrolled with a post-intervention response rate of 61%. Significant reductions were seen in self-rated needs for care, though there was no significant change in total scores or evidence of a dose response association. The results suggest a plausible association between physical exercise and autonomy which may represent the recovery process following the first episode of psychosis. Further randomised control trials are needed to explore the potential causality and robustness of this change.
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Affiliation(s)
- Benjamin Lambden
- Public Health Sciences, Karolinska Institute, Solnavägen 1, Plan 6, Solna, Stockholm 171 77, Sweden.
| | - Jonas Berge
- Clinical Addiction Research Unit, Lund University, Lund, Sweden
| | - Yvonne Forsell
- Public Health Sciences, Karolinska Institute, Solnavägen 1, Plan 6, Solna, Stockholm 171 77, Sweden
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27
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Exploring predictors of medication adherence among inpatients with schizophrenia in Singapore's mental health settings: A non-experimental study. Arch Psychiatr Nurs 2018; 32:536-548. [PMID: 30029745 DOI: 10.1016/j.apnu.2018.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 01/18/2018] [Accepted: 02/11/2018] [Indexed: 11/20/2022]
Abstract
Schizophrenia is a mental disorder, which is marked by frequent relapses. The main reason for relapse is nonadherence to antipsychotics. A cross-sectional, correlational research study was conducted with a convenience sample of 92 participants. The primary aim of this study was to explore the predictors of medication adherence among inpatients with schizophrenia hospitalised at tertiary hospitals in Singapore. Post-hoc analysis revealed that insight, religion, side effects, types of antipsychotics, social support from significant others, nurse-client relationship, were significant predictive factors. Results from this study added knowledge to the nursing literature about medication adherence of schizophrenia patients and in Singapore setting.
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28
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Herbsleb M, Schumann A, Malchow B, Puta C, Schulze PC, Gabriel HW, Bär KJ. Chronotropic incompetence of the heart is associated with exercise intolerance in patients with schizophrenia. Schizophr Res 2018. [PMID: 29526454 DOI: 10.1016/j.schres.2018.02.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The elevated cardiovascular risk of patients with schizophrenia contributes to a reduced life expectancy of 15-20years. This study investigated whether cardiac autonomic dysfunction (CADF) in schizophrenia is related to chronotropic incompetence, an established cardiovascular risk marker. We investigated thirty-two patients suffering from paranoid schizophrenia and thirty-two control subjects matched for age, sex, body mass index and fat free mass. A cardiopulmonary exercise test (CPET) was performed to study heart rate responses to exercise as well as submaximal (ventilatory threshold 1, VT1) and maximal endurance capacities (peak oxygen consumption, VO2peak; peak power output, Ppeak). In addition, epinephrine and norepinephrine levels were assessed in a subset of patients. Fitness parameters were significantly reduced in all patients. Most investigated physiological parameters were significantly different at rest as well as during peak exercise being in line with previously described CADF in schizophrenia. In particular, 14 out of 32 patients were classified as chronotropically incompetent whereas no control subject was below the cut-off value. In addition, a positive correlation of a slope reflecting chronotropic incompetence with peak oxygen uptake (p<0.001) was observed in patients only indicating a close correlation to the lack of physical fitness. The catecholamine increase was reduced in patients after exercise. This study identified a novel cardiac risk factor in patients with schizophrenia. Moreover, it seems to be associated with reduced physical fitness and indicates targets for exercise intervention studies. Future studies are warranted to elucidate pathophysiological mechanisms of this cardiac condition.
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Affiliation(s)
- Marco Herbsleb
- Department of Sports Medicine and Health Promotion, Friedrich-Schiller-University of Jena, Germany
| | - Andy Schumann
- Psychiatric Brain and Body Research Group, Department of Psychiatry and Psychotherapy, University Hospital Jena, Germany
| | - Berend Malchow
- Psychiatric Brain and Body Research Group, Department of Psychiatry and Psychotherapy, University Hospital Jena, Germany
| | - Christian Puta
- Department of Sports Medicine and Health Promotion, Friedrich-Schiller-University of Jena, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Holger W Gabriel
- Department of Sports Medicine and Health Promotion, Friedrich-Schiller-University of Jena, Germany
| | - Karl-Jürgen Bär
- Psychiatric Brain and Body Research Group, Department of Psychiatry and Psychotherapy, University Hospital Jena, Germany.
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Schmitt A, Maurus I, Rossner MJ, Röh A, Lembeck M, von Wilmsdorff M, Takahashi S, Rauchmann B, Keeser D, Hasan A, Malchow B, Falkai P. Effects of Aerobic Exercise on Metabolic Syndrome, Cardiorespiratory Fitness, and Symptoms in Schizophrenia Include Decreased Mortality. Front Psychiatry 2018; 9:690. [PMID: 30622486 PMCID: PMC6308154 DOI: 10.3389/fpsyt.2018.00690] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/27/2018] [Indexed: 12/25/2022] Open
Abstract
Schizophrenia is a severe psychiatric disorder with a lifetime prevalence of about 1%. People with schizophrenia have a 4-fold higher prevalence of metabolic syndrome than the general population, mainly because of antipsychotic treatment but perhaps also because of decreased physical activity. Metabolic syndrome is a risk factor for cardiovascular diseases, and the risk of these diseases is 2- to 3-fold higher in schizophrenia patients than in the general population. The suicide risk is also higher in schizophrenia, partly as a result of depression, positive, and cognitive symptoms of the disease. The higher suicide rate and higher rate of cardiac mortality, a consequence of the increased prevalance of cardiovascular diseases, contribute to the reduced life expectancy, which is up to 20 years lower than in the general population. Regular physical activity, especially in combination with psychosocial and dietary interventions, can improve parameters of the metabolic syndrome and cardiorespiratory fitness. Furthermore, aerobic exercise has been shown to improve cognitive deficits; total symptom severity, including positive and negative symptoms; depression; quality of life; and global functioning. High-intensity interval endurance training is a feasible and effective way to improve cardiorespiratory fitness and metabolic parameters and has been established as such in somatic disorders. It may have more beneficial effects on the metabolic state than more moderate and continuous endurance training methods, but to date it has not been investigated in schizophrenia patients in controlled, randomized trials. This review discusses physical training methods to improve cardiorespiratory fitness and reduce metabolic syndrome risk factors and symptoms in schizophrenia patients. The results of studies and future high-quality clinical trials are expected to lead to the development of an evidence-based physical training program for patients that includes practical recommendations, such as the optimal length and type of aerobic exercise programs and the ideal combination of exercise, psychoeducation, and individual weight management sessions.
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Affiliation(s)
- Andrea Schmitt
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Isabel Maurus
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Moritz J Rossner
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Astrid Röh
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Moritz Lembeck
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Martina von Wilmsdorff
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Shun Takahashi
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
| | - Boris Rauchmann
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Daniel Keeser
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
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Hidese S, Matsuo J, Ishida I, Hiraishi M, Teraishi T, Ota M, Hattori K, Kunugi H. Relationship of Handgrip Strength and Body Mass Index With Cognitive Function in Patients With Schizophrenia. Front Psychiatry 2018; 9:156. [PMID: 29743873 PMCID: PMC5930849 DOI: 10.3389/fpsyt.2018.00156] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 04/09/2018] [Indexed: 12/20/2022] Open
Abstract
Background: The relationship between muscle strength and cognition in schizophrenia has not been well studied. We investigated the potential relationship of handgrip strength (HGS) score and body mass index (BMI) with cognitive function in patients with schizophrenia. Methods: Participants included 153 patients with schizophrenia (age: 36.9 ± 9.4 years; 82 males) and 328 healthy controls (age: 36.4 ± 10.7 years; 150 males), matched for age, sex, and ethnicity (Japanese). HGS was measured using a digital handgrip dynamometer. Cognitive function was evaluated using the Brief Assessment of Cognition in Schizophrenia (BACS) test. A two-way multivariate analysis of covariance was used to compare HGS scores between the patient and control groups. Multiple regression analyses of BACS scores were performed in the patient and control groups using HGS and BMI scores as independent variables. Results: In the intergroup comparison, significantly lower HGS scores were observed in patients with schizophrenia than in healthy controls (p < 0.05, corrected). In the patient group, there was a significantly positive correlation between HGS scores and BACS composite score (male, p = 0.0014; female, p = 0.0051). However, BMI scores were significantly negatively correlated with the BACS composite score (male, p = 0.0022; female, p = 0.018). Furthermore, the ratio of HGS/BMI was significantly positively correlated with the BACS composite score in the patient group (p = 0.00000018). Conclusions: Cognitive function in patients with schizophrenia is correlated positively with HGS and negatively with BMI. HGS/BMI may thus be a good index for cognitive performance in schizophrenia.
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Affiliation(s)
- Shinsuke Hidese
- Department of Mental Disorder Research, National Center of Neurology and Psychiatry, National Institute of Neuroscience, Tokyo, Japan.,Division of Cognitive and Behavioral Medicine, Department of National Center of Neurology and Psychiatry Brain Physiology and Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Junko Matsuo
- Department of Mental Disorder Research, National Center of Neurology and Psychiatry, National Institute of Neuroscience, Tokyo, Japan
| | - Ikki Ishida
- Department of Mental Disorder Research, National Center of Neurology and Psychiatry, National Institute of Neuroscience, Tokyo, Japan
| | - Moeko Hiraishi
- Department of Mental Disorder Research, National Center of Neurology and Psychiatry, National Institute of Neuroscience, Tokyo, Japan
| | - Toshiya Teraishi
- Department of Mental Disorder Research, National Center of Neurology and Psychiatry, National Institute of Neuroscience, Tokyo, Japan
| | - Miho Ota
- Department of Mental Disorder Research, National Center of Neurology and Psychiatry, National Institute of Neuroscience, Tokyo, Japan
| | - Kotaro Hattori
- Department of Mental Disorder Research, National Center of Neurology and Psychiatry, National Institute of Neuroscience, Tokyo, Japan
| | - Hiroshi Kunugi
- Department of Mental Disorder Research, National Center of Neurology and Psychiatry, National Institute of Neuroscience, Tokyo, Japan.,Division of Cognitive and Behavioral Medicine, Department of National Center of Neurology and Psychiatry Brain Physiology and Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Schmitt A, Falkai P. On the search of new treatment strategies in patients with affective disorders. Eur Arch Psychiatry Clin Neurosci 2017; 267:709-710. [PMID: 29071371 DOI: 10.1007/s00406-017-0844-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Andrea Schmitt
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nußbaumstr. 7, 80336, Munich, Germany.
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nußbaumstr. 7, 80336, Munich, Germany
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Meiring L, Visser M, Themistocleous N. A student-facilitated community-based support group initiative for Mental Health Care users in a Primary Health Care setting. Health SA 2017. [DOI: 10.1016/j.hsag.2017.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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33
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Dean DJ, Bryan AD, Newberry R, Gupta T, Carol E, Mittal VA. A Supervised Exercise Intervention for Youth at Risk for Psychosis: An Open-Label Pilot Study. J Clin Psychiatry 2017; 78:e1167-e1173. [PMID: 29178684 PMCID: PMC5995728 DOI: 10.4088/jcp.16m11365] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 06/05/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVE A rapidly accumulating body of research suggests that exercise can improve symptoms and well-being in patients suffering from psychosis. Exercise may also promote neurogenesis in the hippocampus, a structure that plays an important role in the pathophysiology of psychosis. To date, there has not been an intervention focused on exercise prior to the onset of psychosis, a critical time for prevention of more serious illness. METHODS In this pilot study, 12 young adults at ultrahigh risk (UHR) for psychosis were enrolled in a 12-week open-label exercise intervention. Participants were randomly assigned to exercise 2 or 3 times each week and exercised between 65% and 85% of maximum oxygen capacity (Vo2max) for 30 minutes each session under the supervision of an exercise physiologist. Positive and negative symptoms, social and role functioning, performance on neurocognitive tests, cardiovascular fitness, and hippocampal structure and functional connectivity were evaluated before and after the trial. RESULTS A total of 9 participants completed the exercise intervention. Participants showed improved positive and negative symptoms and social and role functioning; improvement in multiple areas of cognition; and increased functional connectivity between the left hippocampus and occipital cortex after 12 weeks of exercise. CONCLUSIONS The results of this study suggest that exercise interventions are feasible in a UHR sample and may promote improvement in clinical, social, and cognitive domains as well as changes to brain function in regions impacted by the development of psychosis. These findings set the stage for an ongoing phase 2 randomized controlled trial. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02155699.
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Affiliation(s)
- Derek J Dean
- University of Colorado at Boulder, Department of Psychology and Neuroscience, Center for Neuroscience, 345 UCB, Boulder, CO 80309-0345.
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
- Center for Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Angela D Bryan
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
- Center for Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Raeana Newberry
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Tina Gupta
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
| | - Emily Carol
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
- Center for Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
- Department of Psychiatry, Northwestern University, Chicago, Illinois, USA
- Institute for Policy Research, Northwestern University, Evanston, Illinois, USA
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA
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Combining aerobic exercise and repetitive transcranial magnetic stimulation to improve brain function in health and disease. Neurosci Biobehav Rev 2017; 83:11-20. [PMID: 28951250 DOI: 10.1016/j.neubiorev.2017.09.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 08/02/2017] [Accepted: 09/21/2017] [Indexed: 12/22/2022]
Abstract
The aetiology of various psychiatric and neurological disorders may be partially attributable to impairments in neuroplasticity. Developing novel methods of stimulating neuroplasticity is a promising treatment approach to counterbalance these maladaptive influences and alleviate symptomologies. Two non-pharmacological approaches with significant and direct impacts on neuroplasticity are aerobic exercise and repetitive transcranial magnetic stimulation. Aerobic exercise is associated with the promotion of numerous neurotrophic mechanisms at a molecular and cellular level, which have a broad influence on neuroplasticity. Transcranial magnetic stimulation is a form of non-invasive brain stimulation with the capacity to modulate the synaptic efficacy and connectivity of particular brain networks. This review synthesises extant literature to explore the complementary physiological mechanisms targeted by aerobic exercise and repetitive transcranial magnetic stimulation, and to substantiate the hypothesis that the use of these techniques in tandem may result in synergistic impact on neural mechanisms to achieve a more efficacious therapeutic approach for mental disorders.
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35
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Möller HJ. New aspects of the vulnerability stress model in general, its relevance in schizophrenic psychoses and the place of antipsychotics. Eur Arch Psychiatry Clin Neurosci 2017; 267:485-486. [PMID: 28725951 DOI: 10.1007/s00406-017-0825-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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36
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Kurebayashi Y, Otaki J. Association between altered physical activity and neurocognitive function among people with schizophrenia: A minimum 6-months' follow-up study. Compr Psychiatry 2017. [PMID: 28623813 DOI: 10.1016/j.comppsych.2017.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The long-term benefits of physical activity on neurocognitive function among patients with schizophrenia, specifically among inpatients, remain unclear. This preliminary study, with a minimum of 6-months' follow-up, examined alterations in physical activity and neurocognitive function in both inpatients and outpatients with schizophrenia. METHODS Symptoms and neurocognitive function were assessed at 2 intervals using the Positive and Negative Symptom Scale and Cognitrax, respectively. After each testing period, participants wore an accelerometer for 1week to measure their levels and duration of physical activity. After the 6-months' follow-up (average duration, 235.9±36.2days), participants were divided into 2 groups based on either increased or decreased activity, as compared with baseline: increased-activity and decreased-activity groups. RESULTS Of the 29 initially enrolled participants, 25 (mean age, 56.8±11.8years) completed the follow-up. Reaction times in the increased-activity group in daily activity (n=10) improved as compared with the decreased-activity group (n=15). Moreover, cognitive flexibility and executive function improved in the increased-activity group in steps (n=7) compared with the decreased-activity group (n=18). Finally, there was no association between the duration of moderate or vigorous exercise and neurocognitive function. CONCLUSIONS Together, our results suggest that increased daily activity and walking, but not high intensity activity, are associated with improved neurocognitive function in patients with schizophrenia.
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Affiliation(s)
- Yusuke Kurebayashi
- Faculty of Health Sciences, Kyorin University, 5-4-1 Shimorenjaku, Mitaka City, Tokyo, Japan.
| | - Junichi Otaki
- Faculty of Health Sciences, Kyorin University, 5-4-1 Shimorenjaku, Mitaka City, Tokyo, Japan.
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37
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Papiol S, Popovic D, Keeser D, Hasan A, Schneider-Axmann T, Degenhardt F, Rossner MJ, Bickeböller H, Schmitt A, Falkai P, Malchow B. Polygenic risk has an impact on the structural plasticity of hippocampal subfields during aerobic exercise combined with cognitive remediation in multi-episode schizophrenia. Transl Psychiatry 2017; 7:e1159. [PMID: 28654095 PMCID: PMC5537649 DOI: 10.1038/tp.2017.131] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/12/2017] [Accepted: 05/17/2017] [Indexed: 02/06/2023] Open
Abstract
Preliminary studies suggest that, besides improving cognition, aerobic exercise might increase hippocampal volume in schizophrenia patients; however, results are not consistent. Individual mechanisms of volume changes are unknown but might be connected to the load of risk genes. Genome-wide association studies have uncovered the polygenic architecture of schizophrenia. The secondary analysis presented here aimed to determine the modulatory role of schizophrenia polygenic risk scores (PRSs) on volume changes in the total hippocampus and cornu ammonis (CA) 1, CA2/3, CA4/dentate gyrus (DG) and subiculum over time. We studied 20 multi-episode schizophrenia patients and 23 healthy controls who performed aerobic exercise (endurance training) combined with cognitive remediation for 3 months and 21 multi-episode schizophrenia patients allocated to a control intervention (table soccer) combined with cognitive remediation. Magnetic resonance imaging-based assessments were performed at baseline and after 3 months with FreeSurfer. No effects of PRSs were found on total hippocampal volume change. Subfield analyses showed that the volume changes between baseline and 3 months in the left CA4/DG were significantly influenced by PRSs in schizophrenia patients performing aerobic exercise. A larger genetic risk burden was associated with a less pronounced volume increase or a decrease in volume over the course of the exercise intervention. Results of exploratory enrichment analyses reinforced the notion of genetic risk factors modulating biological processes tightly related to synaptic ion channel activity, calcium signaling, glutamate signaling and regulation of cell morphogenesis. We hypothesize that a high polygenic risk may negatively influence neuroplasticity in CA4/DG during aerobic exercise in schizophrenia.
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Affiliation(s)
- S Papiol
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Munich, Germany
- Institute of Psychiatric Phenomics and Genomics (IPPG), Medical Center of the University of Munich, Munich, Germany
| | - D Popovic
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Munich, Germany
| | - D Keeser
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Munich, Germany
- Institute of Clinical Radiology, Ludwig Maximilian University Munich, Munich, Germany
| | - A Hasan
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Munich, Germany
| | - T Schneider-Axmann
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Munich, Germany
| | - F Degenhardt
- Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - M J Rossner
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Munich, Germany
| | - H Bickeböller
- Department of Genetic Epidemiology, University Medical Center, Georg-August-Universität Göttingen, Göttingen, Germany
| | - A Schmitt
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Munich, Germany
- Laboratory of Neuroscience, Institute of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil
| | - P Falkai
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Munich, Germany
| | - B Malchow
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Munich, Germany
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38
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Sumskis S, Moxham L, Caputi P. Meaning of resilience as described by people with schizophrenia. Int J Ment Health Nurs 2017; 26:273-284. [PMID: 27862846 DOI: 10.1111/inm.12268] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2016] [Indexed: 11/30/2022]
Abstract
The aim of the present study was to understand the meaning of resilience, as described by people with schizophrenia. Building resilience is a component of recovery-oriented mental health care, and yet almost no research has been conducted into the resilience of people who live with schizophrenia and who are routinely considered vulnerable. Establishing the meaning of resilience in the context of schizophrenia is an important first step in building understanding. van Kaam's psychophenomenological method was used to interpret 14 interviews with people with schizophrenia who are currently well and living in the community. Resilience is invoked in the tension between opposing forces of challenge and support and in the act of 'striving' to take control of schizophrenia. Striving includes repeated, seemingly backwards steps, and during this, the person takes risks and seeks out and uses supportive people and resources. Those same supportive people and resources can also be challenging. Resilience is an energy embedded in the process of recovery from schizophrenia, and is manifest in an attitude of striving. Taking on challenges and engaging in risk is important within treatment and recovery from schizophrenia.
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Affiliation(s)
- Susan Sumskis
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
| | - Lorna Moxham
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
| | - Peter Caputi
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
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Solé B, Jiménez E, Torrent C, Reinares M, Bonnin CDM, Torres I, Varo C, Grande I, Valls E, Salagre E, Sanchez-Moreno J, Martinez-Aran A, Carvalho AF, Vieta E. Cognitive Impairment in Bipolar Disorder: Treatment and Prevention Strategies. Int J Neuropsychopharmacol 2017; 20:670-680. [PMID: 28498954 PMCID: PMC5570032 DOI: 10.1093/ijnp/pyx032] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 05/08/2017] [Indexed: 12/21/2022] Open
Abstract
Over the last decade, there has been a growing appreciation of the importance of identifying and treating cognitive impairment associated with bipolar disorder, since it persists in remission periods. Evidence indicates that neurocognitive dysfunction may significantly influence patients' psychosocial outcomes. An ever-increasing body of research seeks to achieve a better understanding of potential moderators contributing to cognitive impairment in bipolar disorder in order to develop prevention strategies and effective treatments. This review provides an overview of the available data from studies examining treatments for cognitive dysfunction in bipolar disorder as well as potential novel treatments, from both pharmacological and psychological perspectives. All these data encourage the development of further studies to find effective strategies to prevent and treat cognitive impairment associated with bipolar disorder. These efforts may ultimately lead to an improvement of psychosocial functioning in these patients.
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Affiliation(s)
- Brisa Solé
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Esther Jiménez
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Carla Torrent
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Maria Reinares
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Caterina del Mar Bonnin
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Imma Torres
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Cristina Varo
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Iria Grande
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Elia Valls
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Estela Salagre
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Jose Sanchez-Moreno
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Anabel Martinez-Aran
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - André F Carvalho
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Eduard Vieta
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
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Abstract
PURPOSE OF REVIEW Schizophrenia is a severe neuropsychiatric disorder with incomplete remission because of negative and cognitive symptoms in a large proportion of patients. Antipsychotic medication is successful in modulating positive symptoms, but only to a lower extent negative symptoms including cognitive dysfunction. Therefore, development of innovative add-on treatment is highly needed. In this review, recent evidence from clinical studies reveals effects of aerobic exercise on cognitive deficits in schizophrenia patients. RECENT FINDINGS First studies and meta-analyses on aerobic exercise in schizophrenia patients have shown effects on positive, negative, and global symptoms and cognitive domains such as global cognition, working memory, and attention. Underlying neurobiological mechanisms such as neuroplasticity-related synaptogenesis and neurogenesis have been identified in animal studies and possibly mediate effects of aerobic exercise on brain structure and function. SUMMARY Different aspects of methods (e.g., endurance training versus yoga and Tai Chi), length and dose of the intervention, supervision of patients by sports therapists as well as maintenance of cognitive improvement after cessation of training have been raised by previous studies. However, minimal and most effective dosage of the intervention and mechanisms underlying changes in neuroplasticity need to be answered in future basic and large-scale randomized clinical trials.
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Abstract
Schizophrenia is a devastating mental illness that has profound effects on a person's health and quality of life. Exercise represents a promising new treatment option that may supplement current psychosocial and pharmacological interventions for psychosis. A large body of work suggests that exercise can improve cardio-metabolic and health behavior and facilitate neurogenesis in areas of the brain that are notably impacted by psychosis. Recent efforts to incorporate exercise as either stand-alone or adjunctive treatment for individuals with schizophrenia range from yoga and light stretching to moderately intense walking, bike riding, or team sports. These interventions suggest that moderately intense exercise may be beneficial for improving both positive and negative symptomatology, cognition and functioning. Indeed, exercise may be beneficial for decreasing risk factors for a wide range of health problems often observed in patients with schizophrenia, including weight gain and metabolic syndrome as well as tobacco and substance use. Given the positive results from interventions in schizophrenia patients, there is an impetus for incorporating exercise in the early stages of the disorder. Notably, individuals at ultrahigh risk (UHR) for psychosis report more sedentary behavior and perceive less benefit from exercise; interventions prior to the onset of the disorder may be helpful for increasing health behaviors, perhaps delaying or preventing the onset of psychosis. Taken together, for individuals with psychosis, exercise may provide holistic benefits for the neural to the social impairments.
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A randomised controlled trial of adjunctive yoga and adjunctive physical exercise training for cognitive dysfunction in schizophrenia. Acta Neuropsychiatr 2017; 29:102-114. [PMID: 27514629 PMCID: PMC5303681 DOI: 10.1017/neu.2016.42] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Yoga and physical exercise have been used as adjunctive intervention for cognitive dysfunction in schizophrenia (SZ), but controlled comparisons are lacking. Aims A single-blind randomised controlled trial was designed to evaluate whether yoga training or physical exercise training enhance cognitive functions in SZ, based on a prior pilot study. METHODS Consenting, clinically stable, adult outpatients with SZ (n=286) completed baseline assessments and were randomised to treatment as usual (TAU), supervised yoga training with TAU (YT) or supervised physical exercise training with TAU (PE). Based on the pilot study, the primary outcome measure was speed index for the cognitive domain of 'attention' in the Penn computerised neurocognitive battery. Using mixed models and contrasts, cognitive functions at baseline, 21 days (end of training), 3 and 6 months post-training were evaluated with intention-to-treat paradigm. RESULTS Speed index of attention domain in the YT group showed greater improvement than PE at 6 months follow-up (p<0.036, effect size 0.51). In the PE group, 'accuracy index of attention domain showed greater improvement than TAU alone at 6-month follow-up (p<0.025, effect size 0.61). For several other cognitive domains, significant improvements were observed with YT or PE compared with TAU alone (p<0.05, effect sizes 0.30-1.97). CONCLUSIONS Both YT and PE improved attention and additional cognitive domains well past the training period, supporting our prior reported beneficial effect of YT on speed index of attention domain. As adjuncts, YT or PE can benefit individuals with SZ.
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Docx L, Emsell L, Van Hecke W, De Bondt T, Parizel PM, Sabbe B, Morrens M. White matter microstructure and volitional motor activity in schizophrenia: A diffusion kurtosis imaging study. Psychiatry Res Neuroimaging 2017; 260:29-36. [PMID: 28012424 DOI: 10.1016/j.pscychresns.2016.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 09/18/2016] [Accepted: 10/14/2016] [Indexed: 12/13/2022]
Abstract
Avolition is a core feature of schizophrenia and may arise from altered brain connectivity. Here we used diffusion kurtosis imaging (DKI) to investigate the association between white matter (WM) microstructure and volitional motor activity. Multi-shell diffusion MRI and 24-h actigraphy data were obtained from 20 right-handed patients with schizophrenia and 16 right-handed age and gender matched healthy controls. We examined correlations between fractional anisotropy (FA), mean diffusivity (MD), mean kurtosis (MK), and motor activity level, as well as group differences in these measures. In the patient group, increasing motor activity level was positively correlated with MK in the inferior, medial and superior longitudinal fasciculus, the corpus callosum, the posterior fronto-occipital fasciculus and the posterior cingulum. This association was not found in control subjects or in DTI measures. These results show that a lack of volitional motor activity in schizophrenia is associated with potentially altered WM microstructure in posterior brain regions associated with cognitive function and motivation. This could reflect both illness related dysconnectivity which through altered cognition, manifests as reduced volitional motor activity, and/or the effects of reduced physical activity on brain WM.
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Affiliation(s)
- Lise Docx
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; PC Broeders Alexianen Boechout, Provinciesteenweg 408, 2530 Boechout, Belgium.
| | - Louise Emsell
- University Psychiatry Centre (UPC)-KU Leuven, Leuven, Belgium
| | - Wim Van Hecke
- Department of Radiology, Antwerp University Hospital & University of Antwerp, Antwerp, Belgium
| | - Timo De Bondt
- Department of Radiology, Antwerp University Hospital & University of Antwerp, Antwerp, Belgium
| | - Paul M Parizel
- Department of Radiology, Antwerp University Hospital & University of Antwerp, Antwerp, Belgium
| | - Bernard Sabbe
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; PZ St Norbertus Duffel, Stationsstraat 25c, 2570 Duffel, Belgium
| | - Manuel Morrens
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; PC Broeders Alexianen Boechout, Provinciesteenweg 408, 2530 Boechout, Belgium
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Sfera A, Osorio C, Inderias LA, Parker V, Price AI, Cummings M. The Obesity-Impulsivity Axis: Potential Metabolic Interventions in Chronic Psychiatric Patients. Front Psychiatry 2017; 8:20. [PMID: 28243210 PMCID: PMC5303716 DOI: 10.3389/fpsyt.2017.00020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 01/25/2017] [Indexed: 12/20/2022] Open
Abstract
Pathological impulsivity is encountered in a broad range of psychiatric conditions and is thought to be a risk factor for aggression directed against oneself or others. Recently, a strong association was found between impulsivity and obesity which may explain the high prevalence of metabolic disorders in individuals with mental illness even in the absence of exposure to psychotropic drugs. As the overlapping neurobiology of impulsivity and obesity is being unraveled, the question asked louder and louder is whether they should be treated concomitantly. The treatment of obesity and metabolic dysregulations in chronic psychiatric patients is currently underutilized and often initiated late, making correction more difficult to achieve. Addressing obesity and metabolic dysfunction in a preventive manner may not only lower morbidity and mortality but also the excessive impulsivity, decreasing the risk for aggression. In this review, we take a look beyond psychopharmacological interventions and discuss dietary and physical therapy approaches.
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Affiliation(s)
- Adonis Sfera
- Patton State Hospital, Psychiatry, Patton, CA, USA
| | | | | | | | - Amy I. Price
- Oxford University, Evidence Based Medicine, Oxford, UK
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Kurebayashi Y, Otaki J. Correlations between physical activity and neurocognitive domain functions in patients with schizophrenia: a cross-sectional study. BMC Psychiatry 2017; 17:4. [PMID: 28056892 PMCID: PMC5217227 DOI: 10.1186/s12888-016-1176-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 12/23/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Neurocognitive dysfunction is a critical target symptom of schizophrenia treatment. A positive correlation between physical activity level and neurocognitive function has been reported in healthy individuals, but it is unclear whether such a correlation exists in patients with schizophrenia and whether the relationship is different according to inpatients or outpatients. This study aimed to examine the differences in the correlations between physical activity and multiple neurocognitive domains in inpatients and outpatients with schizophrenia and obtain suggestions for further study to facilitate this field. METHODS Twenty-nine patients with schizophrenia were examined (16 inpatients and 13 outpatients, 56.0 ± 11.4 years of age). Current symptoms were assessed using the Positive and Negative Symptom Scale and neurocognitive functions using Cognitrax, which yields a composite neurocognitive index (NCI) and 11 domain scores. After testing, participants wore an HJA-750C accelerometer for one week to measure physical activity levels and durations. Partial correlation analyses were performed between exercise and cognitive parameters. RESULTS In the outpatient group, higher physical activity was associated with faster Motor and Psychomotor Speeds in outpatients. However, higher physical activity was associated with lower overall NCI, Attention score, and Memory scores in inpatients. CONCLUSION Although higher physical activity was associated with better neurocognitive functions of outpatients, in inpatients with non-remitted schizophrenia, higher physical activity was associated with worsening of several cognitive domains. In a future study examining the relationship between physical activity and neurocognitive function for facilitating this research field, separation between inpatients and outpatients are needed because the relationship is different between inpatients and outpatients.
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Affiliation(s)
- Yusuke Kurebayashi
- Faculty of Nursing, Kansai University of Health Science, 2-11-1 Wakaba, Kumatori, Sennan, Osaka, Japan.
| | - Junichi Otaki
- Graduate School of Health Science, Kyorin University, 476 Miyashia cho, Hachioji City, Tokyo Japan
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Jahshan C, Rassovsky Y, Green MF. Enhancing Neuroplasticity to Augment Cognitive Remediation in Schizophrenia. Front Psychiatry 2017; 8:191. [PMID: 29021765 PMCID: PMC5623668 DOI: 10.3389/fpsyt.2017.00191] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 09/15/2017] [Indexed: 12/17/2022] Open
Abstract
There is a burgeoning need for innovative treatment strategies to improve the cognitive deficits in schizophrenia. Cognitive remediation (CR) is effective at the group level, but the variability in treatment response is large. Given that CR may depend on intact neuroplasticity to produce cognitive gains, it is reasonable to combine it with strategies that harness patients' neuroplastic potential. In this review, we discuss two non-pharmacological approaches that can enhance neuroplasticity and possibly augment the effects of CR in schizophrenia: physical exercise and transcranial direct current stimulation (tDCS). Substantial body of evidence supports the beneficial effect of physical exercise on cognition, and a handful of studies in schizophrenia have shown that physical exercise in conjunction with CR has a larger impact on cognition than CR alone. Physical exercise is thought to stimulate neuroplasticity through the regulation of central growth factors, and current evidence points to brain-derived neurotrophic factor as the potential underlying mechanism through which physical exercise might enhance the effectiveness of CR. tDCS has emerged as a potential tool for cognitive enhancement and seems to affect the cellular mechanisms involved in long-term potentiation (LTP). A few reports have demonstrated the feasibility of integrating tDCS with CR in schizophrenia, but there are insufficient data to determine if this multimodal approach leads to incremental performance gain in patients. Larger randomized controlled trials are necessary to understand the mechanisms of the combined tDCS-CR intervention. Future research should take advantage of new developments in neuroplasticity paradigms to examine the effects of these interventions on LTP.
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Affiliation(s)
- Carol Jahshan
- VISN-22 Mental Illness Research, Education and Clinical Center (MIRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Yuri Rassovsky
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Psychology, Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel
| | - Michael F Green
- VISN-22 Mental Illness Research, Education and Clinical Center (MIRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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Preliminary Effectiveness and Sustainability of Group Aerobic Exercise Program in Patients with Schizophrenia. J Nerv Ment Dis 2016; 204:644-50. [PMID: 27218221 DOI: 10.1097/nmd.0000000000000534] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study was to examine the feasibility and sustained effect of a group aerobic exercise program in patients with schizophrenia. Twenty-four schizophrenic patients participated in a group-based individually tailored 90-minute outdoor cycling session per week for 3 months with intervention to enhance motivation. Physical health was evaluated by anthropometric measures, cardiorespiratory (CR) fitness, and blood tests. Mental health was assessed on self-esteem, interpersonal relationship, quality of life, and global function. Attrition rate for the exercise program was 8.3%. Exercise program significantly increased participant's self-esteem, positive relationship, global function, and quality of life. CR fitness significantly improved after 3 months. At the 9-month follow-up, 6 months after program completion, only in interpersonal relationship change the improved effects were maintained. These findings support the feasibility of group aerobic exercise program with high level of adherence and its long-term benefits in positive relationship change.
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Chen LJ, Steptoe A, Chung MS, Ku PW. Association between actigraphy-derived physical activity and cognitive performance in patients with schizophrenia. Psychol Med 2016; 46:2375-2384. [PMID: 27283122 DOI: 10.1017/s0033291716000921] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND An association between low levels of physical activity and impaired cognitive performance in schizophrenia has been proposed, but most studies have relied on self-report measures of activity. This study examined the association between actigraphy-derived physical activity and cognitive performance adjusting for multiple covariates in patients with schizophrenia. METHOD Patients with schizophrenia (n = 199) were recruited from chronic psychiatric wards, and 60 age-, sex- and body mass index-matched comparison participants were recruited from the staff of two hospitals and universities. Physical activity was assessed objectively for 7 days using an ActiGraph. Cognitive performance was assessed with the Cognitrone test from the Vienna Test System and the Grooved Pegboard Test. Demographic variables, metabolic parameters, positive and negative symptoms, duration of illness and hospitalization, and medication use were included as covariates. Pearson correlations and multivariable linear regressions were conducted to examine the associations between physical activity levels and cognitive performance. RESULTS Patients with schizophrenia were less physically active and had poorer performance on attention/concentration and speed of processing than the comparison group. Patients with schizophrenia who spent more time in light physical activity showed better performance on attention/concentration (β = 0.198, p = 0.020) and speed of processing (β= -0.169, p = 0.048) tasks than those who were less active. Cognitive performance was also associated with moderate-vigorous physical activity, but the effect was no longer significant once light physical activity had been taken into account. CONCLUSIONS This study provides evidence for a positive association between objectively measured light physical activity and cognitive performance in people with schizophrenia, after adjustment for multiple confounders.
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Affiliation(s)
- L-J Chen
- Department of Exercise Health Science,National Taiwan University of Sport,271 Lixing Road,Taichung 404,Taiwan
| | - A Steptoe
- Department of Epidemiology and Public Health,University College London,1-19 Torrington Place,London WC1E 6BT,UK
| | - M-S Chung
- Jianan Psychiatric Center,Ministry of Health and Welfare,80, Lane 870,Zhongshan Road,Tainan 717,Taiwan
| | - P-W Ku
- Department of Epidemiology and Public Health,University College London,1-19 Torrington Place,London WC1E 6BT,UK
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Keller-Varady K, Hasan A, Schneider-Axmann T, Hillmer-Vogel U, Adomßent B, Wobrock T, Schmitt A, Niklas A, Falkai P, Malchow B. Endurance training in patients with schizophrenia and healthy controls: differences and similarities. Eur Arch Psychiatry Clin Neurosci 2016; 266:461-73. [PMID: 26541835 DOI: 10.1007/s00406-015-0651-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/26/2015] [Indexed: 11/29/2022]
Abstract
The aims were to examine the feasibility of and adaptations to endurance training in persons diagnosed with schizophrenia and to address the question whether the principles and beneficial effects of endurance training established in the healthy population apply also to patients with schizophrenia. In this controlled interventional study, 22 patients with schizophrenia and 22 healthy controls performed a standardized aerobic endurance training on bicycle ergometers over 12 weeks. Another group of 21 patients with schizophrenia played table soccer. Endurance capacity was measured with incremental cycle ergometry before and after the intervention and 3 months later. A specific set of outcome parameters was defined. The training stimuli can be assumed to be similar in both endurance groups. Endurance capacity improved significantly in the endurance groups, but not in the table soccer group. Patients and healthy controls showed comparable adaptations to endurance training, as assessed by physical working capacity and maximal achieved power. Differences were found in changes of performance at a lactate concentration of 3 mmol/l. Endurance training was feasible and effective in both groups. The principles and types of training that are usually applied to healthy controls need to be verified in patients with schizophrenia. Nevertheless, patients benefited from endurance training in terms of improvement of endurance capacity and reduction in the baseline deficit in comparison with healthy controls. Therefore, endurance training should be implemented in future therapy programs. These programs need to pay special attention to the differences between patients with schizophrenia and healthy controls.
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Affiliation(s)
- Katriona Keller-Varady
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nußbaumstraße 7, 80336, Munich, Germany.
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nußbaumstraße 7, 80336, Munich, Germany
| | - Thomas Schneider-Axmann
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nußbaumstraße 7, 80336, Munich, Germany
| | - Ursula Hillmer-Vogel
- Department of Sports Medicine, University Medical Center Göttingen, Sprangerweg 2, 37075, Göttingen, Germany
| | - Björn Adomßent
- Department of Sports Medicine, University Medical Center Göttingen, Sprangerweg 2, 37075, Göttingen, Germany
| | - Thomas Wobrock
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.,Centre of Mental Health, County Hospitals Darmstadt-Dieburg, Krankenhausstraße 7, 64823, Groß-Umstadt, Germany
| | - Andrea Schmitt
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nußbaumstraße 7, 80336, Munich, Germany.,Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of Sao Paulo, Rua Dr. Ovidio Pires de Campos 785, Sao Paulo, SP, 05453-010, Brazil
| | - Andree Niklas
- Department of Sports Medicine, University Medical Center Göttingen, Sprangerweg 2, 37075, Göttingen, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nußbaumstraße 7, 80336, Munich, Germany
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nußbaumstraße 7, 80336, Munich, Germany
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50
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Kandola A, Hendrikse J, Lucassen PJ, Yücel M. Aerobic Exercise as a Tool to Improve Hippocampal Plasticity and Function in Humans: Practical Implications for Mental Health Treatment. Front Hum Neurosci 2016; 10:373. [PMID: 27524962 PMCID: PMC4965462 DOI: 10.3389/fnhum.2016.00373] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 07/11/2016] [Indexed: 12/24/2022] Open
Abstract
Aerobic exercise (AE) has been widely praised for its potential benefits to cognition and overall brain and mental health. In particular, AE has a potent impact on promoting the function of the hippocampus and stimulating neuroplasticity. As the evidence-base rapidly builds, and given most of the supporting work can be readily translated from animal models to humans, the potential for AE to be applied as a therapeutic or adjunctive intervention for a range of human conditions appears ever more promising. Notably, many psychiatric and neurological disorders have been associated with hippocampal dysfunction, which may underlie the expression of certain symptoms common to these disorders, including (aspects of) cognitive dysfunction. Augmenting existing treatment approaches using AE based interventions may promote hippocampal function and alleviate cognitive deficits in various psychiatric disorders that currently remain untreated. Incorporating non-pharmacological interventions into clinical treatment may also have a number of other benefits to patient well being, such as limiting the risk of adverse side effects. This review incorporates both animal and human literature to comprehensively detail how AE is associated with cognitive enhancements and stimulates a cascade of neuroplastic mechanisms that support improvements in hippocampal functioning. Using the examples of schizophrenia and major depressive disorder, the utility and implementation of an AE intervention to the clinical domain will be proposed, aimed to reduce cognitive deficits in these, and related disorders.
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Affiliation(s)
- Aaron Kandola
- Brain and Mental Health Lab, School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, MelbourneVIC, Australia; Amsterdam Brain and Cognition, University of AmsterdamAmsterdam, Netherlands
| | - Joshua Hendrikse
- Brain and Mental Health Lab, School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne VIC, Australia
| | - Paul J Lucassen
- Centre for Neuroscience, Swammerdam Institute of Life Sciences, University of Amsterdam Amsterdam, Netherlands
| | - Murat Yücel
- Brain and Mental Health Lab, School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne VIC, Australia
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