1
|
Khedr MA, El-Ashry AM, El-Sayed MM, Elkot MA, Hussein RM. The effect of physical exercises program on social functioning, alexithymia, and sense of coherence among patients with bipolar disorders: A randomized control trial. Arch Psychiatr Nurs 2024; 49:83-92. [PMID: 38734459 DOI: 10.1016/j.apnu.2024.02.002] [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: 04/12/2023] [Revised: 07/15/2023] [Accepted: 02/09/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Despite evidence that physical exercises have been helpful in the treatment of various psychiatric disorders, it is unclear whether these data can be generalized to bipolar disorder. The use of physical exercises is challenging and hopeful among patients with bipolar disorders. Few studies have examined the efficacy of physical exercise for patients with bipolar disorders. OBJECTIVE Investigate the effect of applying physical exercises program on social functioning, alexithymia, and sense of coherence among patients with bipolar disorders. METHODS This study followed a randomized control trial design "pre and post-test." Patients were randomly allocated to intervention (n = 25) and control groups (Waiting list) (n = 25). The Social Functioning Scale, Toronto Alexithymia Scale, and Sense of Coherence scales were applied in the study. Pre-test and post-tests were administered to investigate the effect of applying the physical exercises program between December 2022 to March 2023. RESULTS A statistically significant increase in the mean sense of coherence and social functioning scores among the study group. Mean alexithymia scores were significantly decreased among the study group between pre, immediately after, and after a three-month follow-up period. CONCLUSION Physical exercises are an adjunctive treatment modality that is helpful for patients with bipolar disorders. Nurse educators and service providers should reconsider the physical health care requirements for patients with bipolar disorders to equip them to manage the common comorbidities in people with mental illness.
Collapse
Affiliation(s)
- Mahmoud Abdelwahab Khedr
- Department of Nursing, College of Applied Medical Sciences, Hafr Albatin University, Hafr Albatin, Saudi Arabia.
| | - Ayman Mohamed El-Ashry
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Alexandria University, Egypt.
| | - Mona Metwally El-Sayed
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Alexandria University, Egypt.
| | - Mohamed Ali Elkot
- Department of Exercises, Faculty of Sports Education for Men, Alexandria University, Egypt.
| | - Rash Mohamed Hussein
- Department of Psychiatric and Mental Health Nursing, Faculty of Nursing, Zagazig University, Zagazig, Egypt; Department of Community and Psychiatric and Mental Health Nursing, College of Nursing, Qassim University, Buraidah, Saudi Arabia.
| |
Collapse
|
2
|
Amiri S, Fathi-Ashtiani M. Exercise Increasing Health-Related Quality of Life in Type 2 Diabetics: A Meta-Analysis. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2022. [DOI: 10.1080/02703181.2022.2154883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Sohrab Amiri
- Medicine, Quran and Hadith Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | |
Collapse
|
3
|
Dalkner N, Bengesser SA, Birner A, Fellendorf FT, Fleischmann E, Großschädl K, Lenger M, Maget A, Platzer M, Queissner R, Schönthaler E, Tmava-Berisha A, Reininghaus EZ. Metabolic Syndrome Impairs Executive Function in Bipolar Disorder. Front Neurosci 2021; 15:717824. [PMID: 34456679 PMCID: PMC8385126 DOI: 10.3389/fnins.2021.717824] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/15/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Metabolic syndrome (MetS) is more prevalent in individuals with bipolar disorder and has a negative impact on cognition, in particular on executive function, which is already impaired in individuals with bipolar disorder compared to healthy controls. Methods: In a cross-sectional study, we compared 148 euthymic patients with bipolar disorder and 117 healthy controls in cognitive function depending on the diagnosis of MetS. A neuropsychological test battery was used including the Trail Making Test A/B, Stroop Color and Word Interference Test, the d2 Test of Attention Revised, and the California Verbal Learning Test. In addition, MetS variables as well as the defining variables waist circumference, serum triglyceride levels, high-density lipoprotein cholesterol levels, blood pressure, fasting glucose levels, and body mass index were compared between patients and controls. In addition, illness-related variables were associated with MetS in individuals with bipolar disorder. Results: The prevalence of MetS in patients with bipolar disorder was higher than in controls (30.4 vs. 15.4%). Patients with bipolar disorder with MetS had impaired executive function compared to patients without MetS or healthy controls with and without MetS (p = 0.020). No MetS effects or interaction MetS × Group was found in attention/processing speed (p = 0.883) and verbal learning/memory (p = 0.373). Clinical variables (illness duration, suicidality, number of affective episodes, medication, age of onset, and history of psychosis) did not relate to MetS in bipolar disorder (p > 0.05). Conclusion: Bipolar disorder comorbid with MetS bears additional risk for impaired executive function. Executive function includes action planning, inhibition, and impulse control and could play a critical role in keeping long-term goals in mind associated with gaining and maintaining a healthy weight.
Collapse
Affiliation(s)
- Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Susanne A Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Armin Birner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Frederike T Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Eva Fleischmann
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Katja Großschädl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Melanie Lenger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Alexander Maget
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Martina Platzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Robert Queissner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Elena Schönthaler
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Adelina Tmava-Berisha
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Eva Z Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| |
Collapse
|
4
|
Nadalin S, Jakovac H, Peitl V, Karlović D, Buretić-Tomljanović A. Dysregulated inflammation may predispose patients with serious mental illnesses to severe COVID‑19 (Review). Mol Med Rep 2021; 24:611. [PMID: 34184073 PMCID: PMC8258463 DOI: 10.3892/mmr.2021.12250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/21/2021] [Indexed: 12/12/2022] Open
Abstract
Genetic and nongenetic factors associated with an increased inflammatory response may mediate a link between severe coronavirus disease 2019 (COVID‑19) and serious mental illness (SMI). However, systematic assessment of inflammatory response‑related factors associated with SMI that could influence COVID‑19 outcomes is lacking. In the present review, dietary patterns, smoking and the use of psychotropic medications are discussed as potential extrinsic risk factors and angiotensin‑converting enzyme (ACE) insertion/deletion (I/D) gene polymorphisms are considered as potential intrinsic risk factors. A genetics‑based prediction model for SMI using ACE‑I/D genotyping is also proposed for use in patients experiencing severe COVID‑19. Furthermore, the literature suggests that ACE inhibitors may have protective effects against SMI or severe COVID‑19, which is often linked to hypertension and other cardiovascular comorbidities. For this reason, we hypothesize that using these medications to treat patients with severe COVID‑19 might yield improved outcomes, including in the context of SMI associated with COVID‑19.
Collapse
Affiliation(s)
- Sergej Nadalin
- Department of Medical Biology and Genetics, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Hrvoje Jakovac
- Department of Physiology and Immunology, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Vjekoslav Peitl
- Department of Psychiatry, Sestre Milosrdnice University Hospital Center and Catholic University of Croatia, 10000 Zagreb, Croatia
| | - Dalibor Karlović
- Department of Psychiatry, Sestre Milosrdnice University Hospital Center and Catholic University of Croatia, 10000 Zagreb, Croatia
| | - Alena Buretić-Tomljanović
- Department of Medical Biology and Genetics, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| |
Collapse
|
5
|
Levenberg K, Hajnal A, George DR, Saunders EFH. Prolonged functional cerebral asymmetry as a consequence of dysfunctional parvocellular paraventricular hypothalamic nucleus signaling: An integrative model for the pathophysiology of bipolar disorder. Med Hypotheses 2020; 146:110433. [PMID: 33317848 DOI: 10.1016/j.mehy.2020.110433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/14/2020] [Accepted: 11/24/2020] [Indexed: 01/09/2023]
Abstract
Approximately 45 million people worldwide are diagnosed with bipolar disorder (BD). While there are many known risk factors and models of the pathologic processes influencing BD, the exact neurologic underpinnings of BD are unknown. We attempt to integrate the existing literature and create a unifying hypothesis regarding the pathophysiology of BD with the hope that a concrete model may potentially facilitate more specific diagnosis, prevention, and treatment of BD in the future. We hypothesize that dysfunctional signaling from the parvocellular neurons of the paraventricular hypothalamic nucleus (PVN) results in the clinical presentation of BD. Functional damage to this nucleus and its signaling pathways may be mediated by myriad factors (e.g. immune dysregulation and auto-immune processes, polygenetic variation, dysfunctional interhemispheric connections, and impaired or overactivated hypothalamic axes) which could help explain the wide variety of clinical presentations along the BD spectrum. The neurons of the PVN regulate ultradian rhythms, which are observed in cyclic variations in healthy individuals, and mediate changes in functional hemispheric lateralization. Theoretically, dysfunctional PVN signaling results in prolonged functional hemispheric dominance. In this model, prolonged right hemispheric dominance leads to depressive symptoms, whereas left hemispheric dominance correlated to the clinical picture of mania. Subsequently, physiologic processes that increase signaling through the PVN (hypothalamic-pituitaryadrenal axis, hypothalamic- pituitary-gonadal axis, and hypothalamic-pituitary-thyroid axis activity, suprachiasmatic nucleus pathways) as well as, neuro-endocrine induced excito-toxicity, auto-immune and inflammatory flairs may induce mood episodes in susceptible individuals. Potentially, ultradian rhythms slowing with age, in combination with changes in hypothalamic axes and maturation of neural circuitry, accounts for BD clinically presenting more frequently in young adulthood than later in life.
Collapse
Affiliation(s)
- Kate Levenberg
- College of Medicine, Penn State University College of Medicine, State College, USA.
| | - Andras Hajnal
- Neural & Behavioral Sciences, Penn State University College of Medicine, State College, USA
| | - Daniel R George
- Department of Humanities, Penn State University College of Medicine, Hershey, USA
| | - Erika F H Saunders
- Psychiatry and Behavioral Health, Penn State University College of Medicine, State College, USA
| |
Collapse
|
6
|
Sá Filho AS, Cheniaux E, de Paula CC, Murillo-Rodriguez E, Teixeira D, Monteiro D, Cid L, Yamamoto T, Telles-Correia D, Imperatori C, Budde H, Machado S. Exercise is medicine: a new perspective for health promotion in bipolar disorder. Expert Rev Neurother 2020; 20:1099-1107. [PMID: 32762382 DOI: 10.1080/14737175.2020.1807329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Similar effects in reducing the symptoms of the mood disorder are reported in the literature compared the action of drugs and aerobic exercise sessions, demonstrating the potential of exercise in the control and mood stabilization. Therefore, there are many reasons to believe that the increased cardiorespiratory fitness (VO2max) can be an important means of protection and a reducing potential of physical and mental damage in bipolar disorders (BD). This review will highlight the current pattern of response of exercise on the pathophysiology of BD, relating the possible mechanisms, and hypotheses based on exercises. AREAS COVERED The mechanism of monoaminergic action and its relationship with exercise, role of physical conditioning and increased VO2Max on neurotrophin release, and new perspectives on long-term exercise will be reviewed. EXPERT OPINION The adaptations to training, although little explored in the context of BD, can induce the expression of substances that co-regulate several processes related to the pathophysiology of BD. Furthermore, high intensity interval training (HIIT) can also be adjusted to improve the physical fitness and health in patients with BD. Future research is needed to adopt a training strategy that is both time efficient and adequate for the population in question.
Collapse
Affiliation(s)
- Alberto Souza Sá Filho
- Department of Physical Education, Paulista University (UNIP) , São Paulo, Brazil.,Department of Physical Education, University Center of Anápolis (Unievangélica) , Anápolis, Brazil
| | - Elie Cheniaux
- School of Medical Sciences, State University of Rio De Janeiro (UERJ) , Rio De Janeiro, Brazil.,Institute of Psychiatry, Federal University of Rio De Janeiro , Rio De Janeiro, Brazil
| | - Carolina Cavalcante de Paula
- Department of Cellular, Tissue and Developmental Biology, The Institute of Biomedical Science, The University of São Paulo (ICB/USP) , São Paulo, Brazil
| | - Eric Murillo-Rodriguez
- International Neuroscience Research Group , Yucatan, México.,Laboratorio De Neurociencias Moleculares E Integrativas, Escuela De Medicina, División Ciencias De La Salud, Universidad Anáhuac Mayab , Mérida, Mexico
| | - Diogo Teixeira
- International Neuroscience Research Group , Yucatan, México.,Faculty of Physical Education and Sport, ULHT , Lisbon, Portugal
| | - Diogo Monteiro
- International Neuroscience Research Group , Yucatan, México.,Research Centre in Sports, Health and Human Development, CIDESD , Rio Maior, Portugal.,Sport Science School of Rio Maior, Polytechnique Institute of Santarém , Rio Maior, Portugal
| | - Luis Cid
- International Neuroscience Research Group , Yucatan, México.,Research Centre in Sports, Health and Human Development, CIDESD , Rio Maior, Portugal.,Sport Science School of Rio Maior, Polytechnique Institute of Santarém , Rio Maior, Portugal
| | - Tetsuya Yamamoto
- International Neuroscience Research Group , Yucatan, México.,Graduate School of Technology, Industrial and Social Sciences, Tokushima University , Tokushima, Japan
| | - Diogo Telles-Correia
- International Neuroscience Research Group , Yucatan, México.,Clínica Universitária De Psicologia E Psiquiatria, Faculdade De Medicina, Universidade De Lisboa , Lisbon, Portugal.,Departamento De Psiquiatria, Faculdade De Medicina, Universidade De Lisboa , Lisbon, Portugal
| | - Claudio Imperatori
- International Neuroscience Research Group , Yucatan, México.,Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190 , Rome, Italy
| | - Henning Budde
- International Neuroscience Research Group , Yucatan, México.,Faculty of Human Sciences, Medical School Hamburg, University of Applied Science and Medical University , Hamburg, Germany
| | - Sergio Machado
- Institute of Psychiatry, Federal University of Rio De Janeiro , Rio De Janeiro, Brazil.,International Neuroscience Research Group , Yucatan, México.,Laboratory of Physical Activity Neuroscience, Physical Activity Sciences Postgraduate Program, Salgado De Oliveira University (UNIVERSO) , Niterói, Brazil.,Laboratory of Physical Activity Neuroscience, Neurodiversity Institute, Queimados , RJ, Brazil
| |
Collapse
|
7
|
Tamura JK, McIntyre RS. Current and Future Vistas in Bipolar Disorder. Curr Behav Neurosci Rep 2020. [DOI: 10.1007/s40473-020-00202-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
8
|
Wang PW, Lin HC, Su CY, Chen MD, Lin KC, Ko CH, Yen CF. Effect of Aerobic Exercise on Improving Symptoms of Individuals With Schizophrenia: A Single Blinded Randomized Control Study. Front Psychiatry 2018; 9:167. [PMID: 29867600 PMCID: PMC5962673 DOI: 10.3389/fpsyt.2018.00167] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/12/2018] [Indexed: 02/03/2023] Open
Abstract
Introduction: Antipsychotic treatment can improve the symptoms of schizophrenia; however, residual symptoms after antipsychotic treatment are frequent. The effects of exercise on the symptoms of schizophrenic patients under antipsychotic treatment are inconclusive. The aim of this randomized case-control study was to examine the effects of aerobic exercise (AE) on the symptoms of schizophrenic patients receiving antipsychotic treatment. Methods: In total, 33 and 29 participants being treated with antipsychotics for schizophrenia were randomly assigned into the aerobic exercise (AE) group and the control group, respectively. The severities of schizophrenic symptoms were measured using the Chinese version of the Positive and Negative Syndrome Scale (PANSS) before, immediately after, and 3 months after the intervention in both groups. Results: In total, 24 participants (72.7%) in the AE group and 22 (75.9%) in the control group completed the study. The results indicated that the severities of positive symptoms and general psychopathology in the AE group significantly decreased during the 12 weeks of intervention but did not further significantly change during the 3-month follow-up period. The severities of negative symptoms in the AE group decreased significantly after 12 weeks of intervention and continued decreasing during the 3-month follow-up period. Interaction effects between time and group on the severities of symptoms on the negative and general psychopathology scales were observed. Conclusion: AE can improve the severities of symptoms on the negative and general psychopathology scales in individuals with schizophrenia being treated with antipsychotics.
Collapse
Affiliation(s)
- Peng-Wei Wang
- Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Huang-Chi Lin
- Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chwen-Yng Su
- Department of Occupational Therapy, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-De Chen
- Department of Occupational Therapy, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuo C Lin
- Division of Physical and Health Education, Center for General Education, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Chih-Hung Ko
- Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Occupational Therapy, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Fang Yen
- Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
9
|
Gender differences in the association between physical activity and cognitive function in individuals with bipolar disorder. J Affect Disord 2017; 221:232-237. [PMID: 28654848 DOI: 10.1016/j.jad.2017.06.048] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 05/31/2017] [Accepted: 06/20/2017] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Bipolar disorder (BD) is accompanied by a high number of comorbidities and associated with an overall increased mortality. Especially obesity, systemic inflammatory processes and cognitive deficits are highly prevalent and increase with the course of illness. Physical activity (PA) is associated with beneficial effects on somatic comorbidities such as obesity or cardiovascular disease in individuals without psychiatric disorder. Furthermore, PA might increase neurocognitive performance and reduce systemic inflammation. OBJECTIVE The aim of the study was to investigate the association between PA and neurocognitive function in euthymic individuals suffering from BD. METHODS AND PARTICIPANTS 120 individuals with BD, euthymic at test time, completed the self-reported International Physical Activity Questionnaire (IPAQ) assessing PA of the past seven days and were accordingly assigned to a specific activity category (low, moderate or vigorous). Furthermore, clinical parameters were gathered and cognitive tests analysing verbal-dependent intelligence, attention, executive functioning as well as memory were administered. RESULTS Female individuals in the vigorous PA group performed significantly higher in most of the cognitive domains compared to females with moderate or low PA. In males, we only found a significant difference in one test for attention between moderate/vigorous and the low activity group. CONCLUSION Differences between PA groups in cognitive performance in female individuals with BD were obvious in almost all cognitive domains. As cognitive deficits are strongly associated with a worse course of disease and outcome, PA might offer a concomitant therapy targeting not only somatic comorbidities such as obesity and cardiovascular disease, but also neurocognition.
Collapse
|
10
|
Phillips C. Physical Activity Modulates Common Neuroplasticity Substrates in Major Depressive and Bipolar Disorder. Neural Plast 2017; 2017:7014146. [PMID: 28529805 PMCID: PMC5424494 DOI: 10.1155/2017/7014146] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/10/2017] [Accepted: 03/16/2017] [Indexed: 12/13/2022] Open
Abstract
Mood disorders (MDs) are chronic, recurrent mental diseases that affect millions of individuals worldwide. Although the biogenic amine model has provided some clinical utility, a need remains to better understand the interrelated mechanisms that contribute to neuroplasticity deficits in MDs and the means by which various therapeutics mitigate them. Of those therapeutics being investigated, physical activity (PA) has shown clear and consistent promise. Accordingly, the aims of this review are to (1) explicate key modulators, processes, and interactions that impinge upon multiple susceptibility points to effectuate neuroplasticity deficits in MDs; (2) explore the putative mechanisms by which PA mitigates these features; (3) review protocols used to induce the positive effects of PA in MDs; and (4) highlight implications for clinicians and researchers.
Collapse
|
11
|
Abstract
PURPOSE OF THE REVIEW The purpose of this review is to critically assess the evidence for exercise as an adjunct intervention for major depressive disorder and bipolar disorder, chronic conditions characterized by frequent comorbid conditions as well as interepisodic symptoms with poor quality of life and impaired functioning. Individuals with these mood disorders are at higher risk of cardiovascular disease and premature death in part because of increased rates of obesity, inactivity, and diabetes mellitus compared to the general population. Exercise may not only mitigate the increased risk of cardiovascular disease, but could also potentially improve the long term outcomes of mood disorders. RECENT FINDINGS We conducted a literature review on the impact of exercise on mood disorders and associated comorbid conditions as well as possible biological mechanisms. We found that exercise impacts both the physical health parameters of mood disorders as well as mental health outcomes. Exercise also positively impacts conditions frequently comorbid with mood disorders (i.e. anxiety, pain, and insomnia). There are multiple candidate biomarkers for exercise, with brain-derived neurotrophic factor and oxidative stress as two main promising components of exercise's anti-depressant effect. SUMMARY Exercise appears to be a promising adjunct treatment for mood disorders. We conclude with recommendations for future research of exercise as an adjunct intervention for mood disorders.
Collapse
|
12
|
Metcalfe AWS, MacIntosh BJ, Scavone A, Ou X, Korczak D, Goldstein BI. Effects of acute aerobic exercise on neural correlates of attention and inhibition in adolescents with bipolar disorder. Transl Psychiatry 2016; 6:e814. [PMID: 27187236 PMCID: PMC5070058 DOI: 10.1038/tp.2016.85] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 03/29/2016] [Accepted: 03/31/2016] [Indexed: 12/15/2022] Open
Abstract
Executive dysfunction is common during and between mood episodes in bipolar disorder (BD), causing social and functional impairment. This study investigated the effect of acute exercise on adolescents with BD and healthy control subjects (HC) to test for positive or negative consequences on neural response during an executive task. Fifty adolescents (mean age 16.54±1.47 years, 56% female, 30 with BD) completed an attention and response inhibition task before and after 20 min of recumbent cycling at ~70% of age-predicted maximum heart rate. 3 T functional magnetic resonance imaging data were analyzed in a whole brain voxel-wise analysis and as regions of interest (ROI), examining Go and NoGo response events. In the whole brain analysis of Go trials, exercise had larger effect in BD vs HC throughout ventral prefrontal cortex, amygdala and hippocampus; the profile of these effects was of greater disengagement after exercise. Pre-exercise ROI analysis confirmed this 'deficit in deactivation' for BDs in rostral ACC and found an activation deficit on NoGo errors in accumbens. Pre-exercise accumbens NoGo error activity correlated with depression symptoms and Go activity with mania symptoms; no correlations were present after exercise. Performance was matched to controls and results survived a series of covariate analyses. This study provides evidence that acute aerobic exercise transiently changes neural response during an executive task among adolescents with BD, and that pre-exercise relationships between symptoms and neural response are absent after exercise. Acute aerobic exercise constitutes a biological probe that may provide insights regarding pathophysiology and treatment of BD.
Collapse
Affiliation(s)
- A W S Metcalfe
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Brain Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - B J MacIntosh
- Brain Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - A Scavone
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - X Ou
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - D Korczak
- Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - B I Goldstein
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
13
|
Subramaniapillai M, Goldstein BI, MacIntosh BJ, Korczak DJ, Ou X, Scavone A, Arbour-Nicitopoulos K, Faulkner G. Characterizing exercise-induced feelings after one bout of exercise among adolescents with and without bipolar disorder. J Affect Disord 2016; 190:467-473. [PMID: 26551406 DOI: 10.1016/j.jad.2015.10.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 09/28/2015] [Accepted: 10/15/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Exercise may be a practical, non-pharmacological strategy for symptom and health management for adolescents with bipolar disorder (BD). The purpose of this study was to determine if adolescents with BD experience changes in exercise-induced feelings from one bout of exercise similar to their otherwise healthy peers. METHODS Thirty-two adolescents with BD (Age (SD)=16.91 (1.4)) and 31 healthy adolescents (Age (SD)=15.68 (1.76)) completed the Exercise-Induced Feeling Inventory (EFI) before and after a 20-min bout of moderate intensity exercise (heart rate goal of 60-80% of the age estimated maximum [220 - 0.7*age]) on a cycle ergometer. Repeated-Measures ANCOVA was conducted on the four EFI subscales, controlling for age and BMI. RESULTS There were no significant between-group differences on any subscales. An increase in Physical Exhaustion was of negligible effect size in both groups (BD: d=0.05; CONTROL d=0.16). There was an improvement in Revitalization (BD: d=0.49; CONTROL d=0.61) and a reduction in Tranquility (BD: d=-0.33; CONTROL d=-0.29) post-exercise of moderate and small effect size, respectively. The control group reported an increase in Positive Engagement that was of small-to-medium effect size, (d=0.41) with negligible change in the BD group (d=0.17). Healthy adolescents reported a significantly greater tolerance for high intensity exercise than adolescents with BD. LIMITATIONS Emotions were only assessed at two time points. CONCLUSIONS Adolescents with BD experience similar exercise-induced emotional benefits as their healthy peers. Experimental research is needed to examine the role of exercise as a strategy to regulate mood-related symptoms.
Collapse
Affiliation(s)
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Department of Psychiatry, Sunnybrook Health Sciences Centre, Canada
| | - Bradley J MacIntosh
- Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, Canada
| | | | - Xiao Ou
- Centre for Youth Bipolar Disorder, Department of Psychiatry, Sunnybrook Health Sciences Centre, Canada
| | - Antonette Scavone
- Centre for Youth Bipolar Disorder, Department of Psychiatry, Sunnybrook Health Sciences Centre, Canada
| | | | - Guy Faulkner
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada; University of British Columbia, Vancouver, BC, Canada.
| |
Collapse
|
14
|
Effects of a single bout of maximal aerobic exercise on BDNF in bipolar disorder: A gender-based response. Psychiatry Res 2015; 229:57-62. [PMID: 26239767 DOI: 10.1016/j.psychres.2015.07.072] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 07/06/2015] [Accepted: 07/26/2015] [Indexed: 01/08/2023]
Abstract
Acute exercise increases brain-derived neurotrophic factor (BDNF) serum levels in majorly depressed and anxious patients. However, to the best of our knowledge, no study has evaluated the acute effects of exercise on BDNF serum levels in Bipolar Disorder (BD). The objective of the present study was to evaluate the peripheral BDNF serum response to a single maximum session of exercise in BD participants and age- and gender-matched healthy participants. BD participants (n=18) and age- and gender-matched healthy participants (n=18) were recruited to perform a single bout of maximal exercise on a cycle ergometer. Blood samples were collected prior to and immediately after the exercise protocol. There was a significant group effect and a significant group x time x gender interaction. BD participants presented significantly higher BDNF serum levels when compared to their healthy control counterparts. Exercise increases the BDNF levels of BD women, but not men.
Collapse
|
15
|
Strassnig MT, Signorile JF, Potiaumpai M, Romero MA, Gonzalez C, Czaja S, Harvey PD. High velocity circuit resistance training improves cognition, psychiatric symptoms and neuromuscular performance in overweight outpatients with severe mental illness. Psychiatry Res 2015; 229:295-301. [PMID: 26187340 DOI: 10.1016/j.psychres.2015.07.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 07/02/2015] [Accepted: 07/04/2015] [Indexed: 11/18/2022]
Abstract
We developed a physical exercise intervention aimed at improving multiple determinants of physical performance in severe mental illness. A sample of 12 (9M, 3F) overweight or obese community-dwelling patients with schizophrenia (n=9) and bipolar disorder (n=3) completed an eight-week, high-velocity circuit resistance training, performed twice a week on the computerized Keiser pneumatic exercise machines, including extensive pre/post physical performance testing. Participants showed significant increases in strength and power in all major muscle groups. There were significant positive cognitive changes, objectively measured with the Brief Assessment of Cognition Scale: improvement in composite scores, processing speed and symbol coding. Calgary Depression Scale for Schizophrenia and Positive and Negative Syndrome Scale total scores improved significantly. There were large gains in neuromuscular performance that have functional implications. The cognitive domains that showed the greatest improvements (memory and processing speed) are most highly predictive of disability in schizophrenia. Moreover, the improvements seen in depression suggest this type of exercise intervention may be a valuable add-on therapy for bipolar depression.
Collapse
Affiliation(s)
- Martin T Strassnig
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Joseph F Signorile
- Laboratory of Neuromuscular Research and Active Aging, Department of Kinesiology and Sports Sciences, University of Miami, Coral Gables, FL, USA; Center on Aging, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Melanie Potiaumpai
- Laboratory of Neuromuscular Research and Active Aging, Department of Kinesiology and Sports Sciences, University of Miami, Coral Gables, FL, USA
| | - Matthew A Romero
- Laboratory of Neuromuscular Research and Active Aging, Department of Kinesiology and Sports Sciences, University of Miami, Coral Gables, FL, USA
| | | | - Sara Czaja
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA; Center on Aging, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA; Center on Aging, Miller School of Medicine, University of Miami, Miami, FL, USA.
| |
Collapse
|
16
|
Abeln V, MacDonald-Nethercott E, Piacentini MF, Meeusen R, Kleinert J, Strueder HK, Schneider S. Exercise in isolation--a countermeasure for electrocortical, mental and cognitive impairments. PLoS One 2015; 10:e0126356. [PMID: 25961821 PMCID: PMC4427298 DOI: 10.1371/journal.pone.0126356] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 04/01/2015] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Mental impairments, including deterioration of mood and cognitive performance, are known to occur during isolation and space missions, but have been insufficiently investigated. Appropriate countermeasures are required, such as exercise, which is known to prevent mood disorders for prolonged space and isolation missions. Based on the interaction of brain activity, mood and cognitive performance, this study aims to investigate the effect of long-term isolation and confinement and the long-term effect of exercise on these parameters. METHODS Eight male volunteers were isolated and confined for about eight month during the winter period at the Antarctic Concordia Station. Every six weeks electroencephalographic measurements were recorded under rest conditions, and cognitive tests and a mood questionnaire were executed. Based individual training logs, subjects were afterwards separated into an active (> 2500 arbitrary training units/interval) or inactive (< 2500 arbitrary training units/interval) group. RESULTS A long-term effect of exercise was observed for brain activity and mood. Regularly active people showed a decreased brain activity (alpha and beta) in the course of isolation, and steady mood. Inactive people instead first increased and than remained at high brain activity accompanied with a deterioration of mood. No effect of exercise and isolation was found for cognitive performance. CONCLUSION The findings point out the positive effect of regularly performed voluntary exercise, supporting subjective mental well-being of long-term isolated people. The choice to be regularly active seems to support mental health, which is not only of interest for future isolation and space missions.
Collapse
Affiliation(s)
- Vera Abeln
- Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany
| | - Eoin MacDonald-Nethercott
- Cambridge University’s Hospitals NHS Trust, Cambridge, United Kingdom
- Institute Paul Emile Victor, Brest, France
| | - Maria Francesca Piacentini
- University of Rome Foro Italico, Rome, Italy
- Faculty of Physical Education and Physiotherapy, Department of Human Physiology, Brussels, Belgium
| | - Romain Meeusen
- Faculty of Physical Education and Physiotherapy, Department of Human Physiology, Brussels, Belgium
- School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Queensland, Australia
| | - Jens Kleinert
- Institute of Psychology, Department of Health and Social Psychology, German Sport University Cologne, Germany
| | - Heiko K. Strueder
- Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany
| | - Stefan Schneider
- Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany
- Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Maroochydore, Queensland, Australia
| |
Collapse
|
17
|
Thomson D, Berk M, Dodd S, Rapado-Castro M, Quirk SE, Ellegaard PK, Berk L, Dean OM. Tobacco use in bipolar disorder. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2015; 13:1-11. [PMID: 25912533 PMCID: PMC4423166 DOI: 10.9758/cpn.2015.13.1.1] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 07/22/2014] [Accepted: 07/23/2014] [Indexed: 12/12/2022]
Abstract
Tobacco use in mental health in general and bipolar disorder in particular remains disproportionally common, despite declining smoking rates in the community. Furthermore, interactions between tobacco use and mental health have been shown, indicating the outcomes for those with mental health disorders are impacted by tobacco use. Factors need to be explored and addressed to improve outcomes for those with these disorders and target specific interventions for people with psychiatric illness to cease tobacco smoking. In the context of bipolar disorder, this review explores; the effects of tobacco smoking on symptoms, quality of life, suicidal behavior, the biological interactions between tobacco use and bipolar disorder, the interactions between tobacco smoking and psychiatric medications, rates and factors surrounding tobacco smoking cessation in bipolar disorder and suggests potential directions for research and clinical translation. The importance of this review is to bring together the current understanding of tobacco use in bipolar disorder to highlight the need for specific intervention.
Collapse
Affiliation(s)
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia.,Department of Psychiatry, University of Melbourne, Parkville, Australia
| | - Seetal Dodd
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong.,Department of Psychiatry, University of Melbourne, Parkville, Australia
| | - Marta Rapado-Castro
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Victoria, Australia.,Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Victoria, Australia.,Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Maranon, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Shae E Quirk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong
| | - Pernille K Ellegaard
- Research Unit, Mental Health Services, Region of Southern Denmark, Esbjerg, Denmark
| | - Lesley Berk
- Centre for Mental Health and Wellbeing Research, School of Psychology, Deakin University, Burwood, Australia
| | - Olivia M Dean
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia.,Department of Psychiatry, University of Melbourne, Parkville, Australia
| |
Collapse
|
18
|
Thomson D, Turner A, Lauder S, Gigler ME, Berk L, Singh AB, Pasco JA, Berk M, Sylvia L. A brief review of exercise, bipolar disorder, and mechanistic pathways. Front Psychol 2015; 6:147. [PMID: 25788889 PMCID: PMC4349127 DOI: 10.3389/fpsyg.2015.00147] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 01/28/2015] [Indexed: 01/09/2023] Open
Abstract
Despite evidence that exercise has been found to be effective in the treatment of depression, it is unclear whether these data can be extrapolated to bipolar disorder. Available evidence for bipolar disorder is scant, with no existing randomized controlled trials having tested the impact of exercise on depressive, manic or hypomanic symptomatology. Although exercise is often recommended in bipolar disorder, this is based on extrapolation from the unipolar literature, theory and clinical expertise and not empirical evidence. In addition, there are currently no available empirical data on program variables, with practical implications on frequency, intensity and type of exercise derived from unipolar depression studies. The aim of the current paper is to explore the relationship between exercise and bipolar disorder and potential mechanistic pathways. Given the high rate of medical co-morbidities experienced by people with bipolar disorder, it is possible that exercise is a potentially useful and important intervention with regard to general health benefits; however, further research is required to elucidate the impact of exercise on mood symptomology.
Collapse
Affiliation(s)
- Daniel Thomson
- Department of Applied Sciences, Royal Melbourne Institute of Technology University , Bundoora, VIC, Australia
| | - Alyna Turner
- Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre, School of Medicine, Deakin University , Geelong, VIC, Australia ; Department of Psychiatry, University of Melbourne , Parkville, VIC, Australia ; Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, University of Newcastle , Callaghan, NSW, Australia
| | - Sue Lauder
- Department of Psychiatry, University of Melbourne , Parkville, VIC, Australia ; Federation University Australia , Ballarat, VIC, Australia
| | - Margaret E Gigler
- Department of Psychiatry, Massachusetts General Hospital , Boston, MA, USA
| | - Lesley Berk
- Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre, School of Medicine, Deakin University , Geelong, VIC, Australia ; Mental Health and Wellbeing Strategic Research Centre, School of Psychology, Deakin University , Geelong, VIC, Australia
| | - Ajeet B Singh
- Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre, School of Medicine, Deakin University , Geelong, VIC, Australia
| | - Julie A Pasco
- Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre, School of Medicine, Deakin University , Geelong, VIC, Australia ; Department of Medicine, NorthWest Academic Centre, University of Melbourne , St Albans, VIC, Australia
| | - Michael Berk
- Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre, School of Medicine, Deakin University , Geelong, VIC, Australia ; Department of Psychiatry, University of Melbourne , Parkville, VIC, Australia ; Florey Institute for Neuroscience and Mental Health , Parkville, VIC, Australia ; Orygen, The National Centre of Excellence in Youth Mental Health , Parkville, VIC, Australia
| | - Louisa Sylvia
- Department of Psychiatry, Massachusetts General Hospital , Boston, MA, USA ; Harvard Medical School, Harvard University , Boston, MA, USA
| |
Collapse
|
19
|
Rosenblat JD, Cha DS, Mansur RB, McIntyre RS. Inflamed moods: a review of the interactions between inflammation and mood disorders. Prog Neuropsychopharmacol Biol Psychiatry 2014; 53:23-34. [PMID: 24468642 DOI: 10.1016/j.pnpbp.2014.01.013] [Citation(s) in RCA: 391] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 12/22/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023]
Abstract
Mood disorders have been recognized by the World Health Organization (WHO) as the leading cause of disability worldwide. Notwithstanding the established efficacy of conventional mood agents, many treated individuals continue to remain treatment refractory and/or exhibit clinically significant residual symptoms, cognitive dysfunction, and psychosocial impairment. Therefore, a priority research and clinical agenda is to identify pathophysiological mechanisms subserving mood disorders to improve therapeutic efficacy. During the past decade, inflammation has been revisited as an important etiologic factor of mood disorders. Therefore, the purpose of this synthetic review is threefold: 1) to review the evidence for an association between inflammation and mood disorders, 2) to discuss potential pathophysiologic mechanisms that may explain this association and 3) to present novel therapeutic options currently being investigated that target the inflammatory-mood pathway. Accumulating evidence implicates inflammation as a critical mediator in the pathophysiology of mood disorders. Indeed, elevated levels of pro-inflammatory cytokines have been repeatedly demonstrated in both major depressive disorder (MDD) and bipolar disorder (BD) patients. Further, the induction of a pro-inflammatory state in healthy or medically ill subjects induces 'sickness behavior' resembling depressive symptomatology. Potential mechanisms involved include, but are not limited to, direct effects of pro-inflammatory cytokines on monoamine levels, dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, pathologic microglial cell activation, impaired neuroplasticity and structural and functional brain changes. Anti-inflammatory agents, such as acetyl-salicylic acid (ASA), celecoxib, anti-TNF-α agents, minocycline, curcumin and omega-3 fatty acids, are being investigated for use in mood disorders. Current evidence shows improved outcomes in mood disorder patients when anti-inflammatory agents are used as an adjunct to conventional therapy; however, further research is needed to establish the therapeutic benefit and appropriate dosage.
Collapse
Affiliation(s)
- Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada; Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Danielle S Cha
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada; Interdisciplinary Laboratory of Clinical Neuroscience (LINC), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil; Program for Recognition and Intervention in Individuals in At-Risk Mental States (PRISMA), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada.
| |
Collapse
|
20
|
Schmitt A, Malchow B, Hasan A, Falkai P. The impact of environmental factors in severe psychiatric disorders. Front Neurosci 2014; 8:19. [PMID: 24574956 PMCID: PMC3920481 DOI: 10.3389/fnins.2014.00019] [Citation(s) in RCA: 195] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 01/23/2014] [Indexed: 01/08/2023] Open
Abstract
During the last decades, schizophrenia has been regarded as a developmental disorder. The neurodevelopmental hypothesis proposes schizophrenia to be related to genetic and environmental factors leading to abnormal brain development during the pre- or postnatal period. First disease symptoms appear in early adulthood during the synaptic pruning and myelination process. Meta-analyses of structural MRI studies revealing hippocampal volume deficits in first-episode patients and in the longitudinal disease course confirm this hypothesis. Apart from the influence of risk genes in severe psychiatric disorders, environmental factors may also impact brain development during the perinatal period. Several environmental factors such as antenatal maternal virus infections, obstetric complications entailing hypoxia as common factor or stress during neurodevelopment have been identified to play a role in schizophrenia and bipolar disorder, possibly contributing to smaller hippocampal volumes. In major depression, psychosocial stress during the perinatal period or in adulthood is an important trigger. In animal studies, chronic stress or repeated administration of glucocorticoids have been shown to induce degeneration of glucocorticoid-sensitive hippocampal neurons and may contribute to the pathophysiology of affective disorders. Epigenetic mechanisms altering the chromatin structure such as histone acetylation and DNA methylation may mediate effects of environmental factors to transcriptional regulation of specific genes and be a prominent factor in gene-environmental interaction. In animal models, gene-environmental interaction should be investigated more intensely to unravel pathophysiological mechanisms. These findings may lead to new therapeutic strategies influencing epigenetic targets in severe psychiatric disorders.
Collapse
Affiliation(s)
- Andrea Schmitt
- Department of Psychiatry and Psychotherapy, LMU Munich Munich, Germany ; Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of Sao Paulo São Paulo, Brazil
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, LMU Munich Munich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, LMU Munich Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, LMU Munich Munich, Germany
| |
Collapse
|
21
|
Malchow B, Reich-Erkelenz D, Oertel-Knöchel V, Keller K, Hasan A, Schmitt A, Scheewe TW, Cahn W, Kahn RS, Falkai P. The effects of physical exercise in schizophrenia and affective disorders. Eur Arch Psychiatry Clin Neurosci 2013; 263:451-67. [PMID: 23873090 DOI: 10.1007/s00406-013-0423-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 07/08/2013] [Indexed: 01/23/2023]
Abstract
Affective and non-affective psychoses are severe and frequent psychiatric disorders. Amongst others, they not only have a profound impact on affected individuals through their symptomatology, but also regarding cognition, brain structure and function. Cognitive impairment influences patients' quality of life as well as their ability to work and being employed. While exercise therapy has been implemented in the treatment of psychiatric conditions since the days of Kraepelin and Bleuler, the underlying mechanisms have never been systematically studied. Since the early 1990s, studies emerged examining the effect of physical exercise in animal models, revealing stimulation of neurogenesis, synaptogenesis and neurotransmission. Based on that body of work, clinical studies have been carried out in both healthy humans and in patient populations. These studies differ with regard to homogenous study samples, sample size, type and duration of exercise, outcome variables and measurement techniques. Based on their review, we draw conclusions regarding recommendations for future research strategies showing that modern therapeutic approaches should include physical exercise as part of a multimodal intervention programme to improve psychopathology and cognitive symptoms in schizophrenia and affective disorders.
Collapse
Affiliation(s)
- Berend Malchow
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nußbaumstraße 7, 80336, Munich, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Lang DJ, Barr AM, Procyshyn RM. Management of Medication-Related Cardiometabolic Risk in Patients with Severe Mental Illness. CURRENT CARDIOVASCULAR RISK REPORTS 2013; 7:283-287. [PMID: 23864926 PMCID: PMC3702958 DOI: 10.1007/s12170-013-0321-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Severe psychotic disorders, which on their own may be a risk factor for metabolic disorder and cardiovascular illness, are clinically compounded by the significant adverse side effects of antipsychotic medications. The majority of patients with severe psychotic disorders (i.e., schizophrenia, bipolar disorder, mania, and depression) must take antipsychotic medications to treat their psychoses and, subsequently, will require efficacious interventions to manage the metabolic consequences of pharmacologic treatment to mitigate excessive mortality associated with cardiovascular illness. We have reviewed the metabolic consequences of antipsychotic treatment and discussed pilot findings from a new nonpharmacologic intervention study looking at the clinical benefits of regular exercise as a management tool for the cardiometabolic risk factors in a cohort with severe mental illness.
Collapse
Affiliation(s)
- Donna J. Lang
- Department of Radiology, University of British Columbia, Centre for Complex Disorders, British Columbia Mental Health and Addictions Research Institute, CFRI Bldg, Rm. 3A-124, 938 West 28th Ave, BC Children’s Hospital Site, Vancouver, BC Canada V5Z 4H4
| | - Alasdair M. Barr
- Department of Pharmacology, British Columbia Mental Health and Addictions Research Institute, Vancouver, BC Canada V5Z 4H4
| | - Ric M. Procyshyn
- Department of Psychiatry, British Columbia Mental Health and Addictions Research Institute, Vancouver, BC Canada V5Z 4H4
| |
Collapse
|
23
|
Entopeduncular nucleus endocannabinoid system modulates sleep–waking cycle and mood in rats. Pharmacol Biochem Behav 2013; 107:29-35. [DOI: 10.1016/j.pbb.2013.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 04/03/2013] [Accepted: 04/06/2013] [Indexed: 11/17/2022]
|
24
|
Vancampfort D, Correll CU, Probst M, Sienaert P, Wyckaert S, De Herdt A, Knapen J, De Wachter D, De Hert M. A review of physical activity correlates in patients with bipolar disorder. J Affect Disord 2013; 145:285-91. [PMID: 22889526 DOI: 10.1016/j.jad.2012.07.020] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 07/16/2012] [Accepted: 07/16/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Existing studies do suggest that physical activity interventions may be feasible and have a role in promoting mental and physical health in patients with bipolar disorder. The present review evaluates systematically quantitative studies of correlates of physical activity in patients with bipolar disorder. METHODS We searched EMBASE, PsycINFO, PubMed, and CINAHL from their inception, combining the medical subject headings 'bipolar disorder' or 'mania' or 'manic depression' with 'physical activity' or 'physical inactivity' or 'exercise'. RESULTS Out of 40 potentially eligible studies, 11 papers evaluating 26 correlates were included. Correlates that were associated with lower physical activity participation were lower self-efficacy, presence of medical co-morbidity, lower educational status and social isolation. Less consistent variables associated with lower physical activity participation included higher BMI, older age, financial strains, not being connected to a health care service, and minority ethnicity. A larger study sample size was related to a higher proportion of significant associations (p=0.04). Current gaps in literature which need to be examined more in detail are the role of psychiatric symptoms, environmental and policy-level factors. LIMITATIONS The diversity of physical activity measures and subject samples prevented us to perform a meta-analysis. CONCLUSIONS All significant correlates should be confirmed in prospective studies and interventions to improve the modifiable variables should be developed and evaluated. The reviewed data also demonstrate that validation studies on physical activity measurements are highly needed.
Collapse
Affiliation(s)
- Davy Vancampfort
- University Psychiatric Center, Catholic University Leuven, Campus Kortenberg, Kortenberg, Belgium.
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Moylan S, Eyre HA, Maes M, Baune BT, Jacka FN, Berk M. Exercising the worry away: how inflammation, oxidative and nitrogen stress mediates the beneficial effect of physical activity on anxiety disorder symptoms and behaviours. Neurosci Biobehav Rev 2013; 37:573-84. [PMID: 23415701 DOI: 10.1016/j.neubiorev.2013.02.003] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 11/27/2012] [Accepted: 02/05/2013] [Indexed: 12/11/2022]
Abstract
Regular physical activity exerts positive effects on anxiety disorder symptoms, although the biological mechanisms underpinning this effect are incompletely understood. Numerous lines of evidence support inflammation and oxidative and nitrogen stress (O&NS) as important in the pathogenesis of mood and anxiety disorders, and physical activity is known to influence these same pathways. This paper reviews the inter-relationships between anxiety disorders, physical activity and inflammation and O&NS, to explore whether modulation of inflammation and O&NS may in part underpin the positive effect of physical activity on anxiety disorders. Numerous studies support the notion that physical activity operates as an anti-inflammatory and anti-O&NS agent which potentially exerts positive effects on neuroplasticity, the expression of neurotrophins and normal neuronal functions. These effects may therefore influence the expression and evolution of anxiety disorders. Further exploration of this area may elicit a deeper understanding of the pathogenesis of anxiety disorders, and inform the development of integrated programmes including PA specifically suited to the treatment and prevention of anxiety disorders and symptoms.
Collapse
Affiliation(s)
- S Moylan
- School of Medicine, Deakin University, Melbourne, Australia.
| | | | | | | | | | | |
Collapse
|
26
|
Lin TW, Kuo YM. Exercise benefits brain function: the monoamine connection. Brain Sci 2013; 3:39-53. [PMID: 24961306 PMCID: PMC4061837 DOI: 10.3390/brainsci3010039] [Citation(s) in RCA: 184] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 10/29/2012] [Accepted: 01/07/2013] [Indexed: 11/17/2022] Open
Abstract
The beneficial effects of exercise on brain function have been demonstrated in animal models and in a growing number of clinical studies on humans. There are multiple mechanisms that account for the brain-enhancing effects of exercise, including neuroinflammation, vascularization, antioxidation, energy adaptation, and regulations on neurotrophic factors and neurotransmitters. Dopamine (DA), noradrenaline (NE), and serotonin (5-HT) are the three major monoamine neurotransmitters that are known to be modulated by exercise. This review focuses on how these three neurotransmitters contribute to exercise affecting brain function and how it can work against neurological disorders.
Collapse
Affiliation(s)
- Tzu-Wei Lin
- Institute of Basic Medical Sciences, National Cheng Kung University, Tainan 70101, Taiwan.
| | - Yu-Min Kuo
- Institute of Basic Medical Sciences, National Cheng Kung University, Tainan 70101, Taiwan.
| |
Collapse
|
27
|
Zschucke E, Gaudlitz K, Ströhle A. Exercise and physical activity in mental disorders: clinical and experimental evidence. J Prev Med Public Health 2013; 46 Suppl 1:S12-21. [PMID: 23412549 PMCID: PMC3567313 DOI: 10.3961/jpmph.2013.46.s.s12] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 12/07/2012] [Indexed: 12/13/2022] Open
Abstract
Several epidemiological studies have shown that exercise (EX) and physical activity (PA) can prevent or delay the onset of different mental disorders, and have therapeutic benefits when used as sole or adjunct treatment in mental disorders. This review summarizes studies that used EX interventions in patients with anxiety, affective, eating, and substance use disorders, as well as schizophrenia and dementia/mild cognitive impairment. Despite several decades of clinical evidence with EX interventions, controlled studies are sparse in most disorder groups. Preliminary evidence suggests that PA/EX can induce improvements in physical, subjective and disorder-specific clinical outcomes. Potential mechanisms of action are discussed, as well as implications for psychiatric research and practice.
Collapse
Affiliation(s)
- Elisabeth Zschucke
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
| | - Katharina Gaudlitz
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
| |
Collapse
|
28
|
Abstract
Bipolar disorder (BD) is associated with obesity, overweight, and abdominal obesity, and BD individuals with obesity have a greater illness burden. Factors related to BD, its treatment, and the individual may all contribute to BD's association with obesity. Management strategies for the obese BD patient include use of medications with better metabolic profiles, lifestyle interventions, and adjunctive pharmacotherapy for weight loss. Obesity-related psychiatric and medical comorbidities should also be assessed and managed. Bariatric surgery may be an option for carefully selected patients. Greater research into the theoretical underpinnings and clinical management of the BD-obesity connection is needed.
Collapse
Affiliation(s)
- Susan L McElroy
- Lindner Center of HOPE, 4075 Old Western Road, Mason, OH 45040, USA.
| | | |
Collapse
|
29
|
Åberg MAI, Waern M, Nyberg J, Pedersen NL, Bergh Y, Åberg ND, Nilsson M, Kuhn HG, Torén K. Cardiovascular fitness in males at age 18 and risk of serious depression in adulthood: Swedish prospective population-based study. Br J Psychiatry 2012; 201:352-9. [PMID: 22700083 DOI: 10.1192/bjp.bp.111.103416] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Studies suggest a role for cardiovascular fitness in the prevention of affective disorders. AIMS To determine whether cardiovascular fitness at age 18 is associated with future risk of serious affective illness. METHOD Population-based Swedish cohort study of male conscripts (n = 1 117 292) born in 1950-1987 with no history of mental illness who were followed for 3-40 years. Data on cardiovascular fitness at conscription were linked with national hospital registers to calculate future risk of depression (requiring in-patient care) and bipolar disorder. RESULTS In fully adjusted models low cardiovascular fitness was associated with increased risk for serious depression (hazard ratios (HR) = 1.96, 95%, CI 1.71-2.23). No such association could be shown for bipolar disorder (HR = 1.11, 95% CI 0.84-1.47). CONCLUSIONS Lower cardiovascular fitness at age 18 was associated with increased risk of serious depression in adulthood. These results strengthen the theory of a cardiovascular contribution to the aetiology of depression.
Collapse
Affiliation(s)
- Maria A I Åberg
- Center for Brain Repair and Rehabilitation, Institute for Neuroscience and Physiology and Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Abstract
OBJECTIVE To review the efficacy of pharmacological agents in bipolar mixed states. METHODS We conducted a PubMed search of all English-language articles involving Food and Drug Administration (FDA)-approved agents for manic/mixed states in adults with bipolar I disorder. We also included names of agents established as efficacious in acute mania/mixed states that have not received FDA approval for bipolar disorder. Bibliographies from relevant articles were also searched. The efficacy of each agent in the mixed state subpopulation was reviewed, as evidenced by change from baseline on total scores of mania [e.g., Young Mania Rating Scale (YMRS)] and depression [e.g., Montgomery-Åsberg Depression Rating Scale (MADRS)] measures. RESULTS No available study is dedicated exclusively to the evaluation of mixed state populations. Although key inclusion and exclusion criteria are similar across treatment studies, mixed states have been variably defined and measured. The use of conventional manic and depressive metrics in bipolar mixed states perpetuates the unproven notion that mixed states are the consequence of coexisting depression and mania. Notwithstanding the methodological limitations, there are numerically more studies that exist for atypical antipsychotic agents than for any other class. On the basis of symptomatic improvement, recommendations for and/or strong admonishments against any established antimanic agents (e.g., lithium) cannot be made. An emergent signal supports combination treatment strategies (e.g., atypical antipsychotic plus divalproex) over mood stabilizer monotherapy (e.g., divalproex). Available evidence does not empirically support the hypothesis that conventional antipsychotics engender and/or amplify depressive symptoms in bipolar mixed states. CONCLUSIONS All proven antimanic agents (including lithium), can be recommended in the treatment of mixed/dysphoric states. The totality of evidence with attention paid to the therapeutic index of each agent would suggest that atypical antipsychotics and divalproex be considered as first-line treatment, with lithium and carbamazepine as second-line. Most individuals will require combination therapy for the treatment of mixed states; variable combinations of atypical antipsychotics and conventional mood stabilizers have the most replicated evidence.
Collapse
Affiliation(s)
- Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
| | | |
Collapse
|
31
|
Exercise and physical activity in mental disorders. Eur Arch Psychiatry Clin Neurosci 2011; 261 Suppl 2:S186-91. [PMID: 21935629 DOI: 10.1007/s00406-011-0254-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 08/17/2011] [Indexed: 01/09/2023]
Abstract
Exercise (EX) and physical activity (PA) have been shown to prevent or delay the onset of several mental disorders and to have therapeutic effects in different groups of psychiatric disorders. This review focuses on studies investigating EX as therapeutic intervention in anxiety disorders, affective disorders, eating disorders, schizophrenia, and substance use disorders. Despite EX being discussed as a potential therapy for several decades, adequately powered randomized, controlled trials are sparse in most disorder groups. Nevertheless, evidence points toward disorder-specific benefits that can be induced by EX/PA. Mechanisms of the therapeutic effects of EX/PA are summarized, including metabolic and physiological as well as psychological aspects. Finally, implications for research and therapeutic practice are illustrated.
Collapse
|
32
|
Brietzke E, Kapczinski F, Grassi-Oliveira R, Grande I, Vieta E, McIntyre RS. Insulin dysfunction and allostatic load in bipolar disorder. Expert Rev Neurother 2011; 11:1017-28. [PMID: 21721918 DOI: 10.1586/ern.10.185] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Bipolar disorder (BD) is associated with substantial morbidity, as well as premature mortality. Available evidence indicates that 'stress-sensitive' chronic medical disorders, such as cardiovascular disease, obesity and Type 2 diabetes mellitus, are critical mediators and/or moderators of BD. Changes in physiologic systems implicated in allostasis have been proposed to impact brain structures and neurocognition, as well as medical comorbidity in this population. For example, abnormalities in insulin physiology, for example, insulin resistance, hyperinsulinemia and central insulinopenia, are implicated as effectors of allostatic load in BD. Insulin's critical role in CNS physiological (e.g., neurotrophism and synaptic plasticity) and pathophysiological (e.g., neurocognitive deficits, pro-apoptosis and amyloid deposition) processes is amply documented. This article introduces the concept that insulin is a mediator of allostatic load in the BD and possibly a therapeutic target.
Collapse
Affiliation(s)
- Elisa Brietzke
- Bipolar Disorder Program, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.
| | | | | | | | | | | |
Collapse
|
33
|
Kucyi A, Alsuwaidan MT, Liauw SS, McIntyre RS. Aerobic physical exercise as a possible treatment for neurocognitive dysfunction in bipolar disorder. Postgrad Med 2011; 122:107-16. [PMID: 21084787 DOI: 10.3810/pgm.2010.11.2228] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Neurocognitive dysfunction associated with bipolar disorder (BD) is pervasive, persistent across illness phases, and is demonstrated to predispose and portend psychosocial impairment. Moreover, no approved therapies for various phases of BD have been shown to reliably improve any dimension of neurocognitive performance. In this article, we emphasize that aerobic physical exercise is a viable neurocognitive-enhancing adjunctive treatment for patients with BD. The overarching aim of this review is to emphasize that aerobic physical exercise is a viable neurocognitive-enhancing adjunctive treatment for patients with BD. METHODS We conducted PubMed and Google Scholar searches of all English-language articles published between January 1966 and February 2010 using the search terms bipolar disorder, major depressive disorder, depression, exercise, and physical activity cross-referenced with each other and the following terms: cognition, executive function, learning, memory, attention, emotion, and behavior. Articles selected for review were based on adequacy of sample size, use of standardized experimental procedures, validated assessment measures, and overall quality. RESULTS Available studies have documented an array of persisting neurocognitive deficits across disparate bipolar populations. Abnormalities in verbal working memory are highly replicated; deficits in executive function, learning, attention, and processing speed are also a consistent abnormality. The effect sizes of neurocognitive deficits in BD are intermediate between those reported in schizophrenia and major depressive disorder. Several original reports and reviews have documented the neurocognitive-enhancing effects of aerobic exercise in the general population as well as across diverse medical populations and ages. Proposed mechanisms involve nonexclusive effects on neurogenesis, neurotrophism, immunoinflammatory systems, insulin sensitivity, and neurotransmitter systems. Each of these effector systems are implicated in both normal and abnormal neurocognitive processes in BD. CONCLUSION Available evidence provides a rationale for empirically evaluating the neurocognitive benefits of aerobic exercise in BD.
Collapse
Affiliation(s)
- Aaron Kucyi
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | | | | | | |
Collapse
|
34
|
Leboyer M, Kupfer DJ. Bipolar disorder: new perspectives in health care and prevention. J Clin Psychiatry 2010; 71:1689-95. [PMID: 21190640 PMCID: PMC3317891 DOI: 10.4088/jcp.10m06347yel] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 08/09/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE High rates of misdiagnosis, delayed diagnosis, and lack of recognition and treatment of comorbid conditions often lead patients with bipolar illness to have a chronic course with high disability, unemployment rates, and mortality. Despite the recognition that long-term outcome of bipolar disorder depends on systematic assessment of both interepisodic dysfunctional domains and comorbid psychiatric and medical conditions, treatment of bipolar disorder still focuses primarily on alleviation of acute symptoms and prevention of future recurrences. We propose here to review the evidence offering a modern view of bipolar disorder defined as a chronic and progressive multisystem disorder, taking into account characteristics of each patient as well as biosignatures in order to help design personalized treatments. DATA SOURCES We conducted a systematic PubMed search of all English-language articles, published between 2000 and 2010, focusing on the English and French literature with bipolar disorder cross-referenced with the following search terms: emotional dysregulation, sleep and circadian rhythm disturbances, cognitive impairment, age at onset, comorbid medical and psychiatric conditions, psychosocial and medical interventions, outcome, remission, and personalized medicine. The search was conducted between July 2009 and July 2010. The literature on bipolar disorder was reviewed to provide supporting evidence that the assessment of various symptom domains that are dysfunctional between episodes should all be considered as core dimensions of the disorder. STUDY SELECTION Forty-one articles were identified through the PubMed search described above and selected on the basis of addressing any combination of the search terms in conjunction with bipolar disorder. DATA SYNTHESIS Current guidelines advocate the use of more or less similar treatment algorithms for all patients, ignoring the clinical, pathophysiological, and lifetime heterogeneity of bipolar disorder. Systematic assessment of interepisodic dimensions, along with comorbid medical and psychiatric risk factors, should be performed along the life cycle in order to plan specific and personalized pharmacologic, medical, and psychosocial interventions tailored to the needs of each patient and ready-to-test biosignatures to serve as risk factors or diagnostic or prognostic tools. CONCLUSIONS Medical and research findings, along with health economic data, support a more modern view of bipolar disorder as a chronic, progressive, multisystem disorder. This new comprehensive framework should guide the search to identify biomarkers and etiologic factors and should help design a new policy for health care, including prevention, diagnosis, treatment, and training.
Collapse
Affiliation(s)
- Marion Leboyer
- Department of Psychiatry, Hôpital Albert Chenevier, University Paris-Est, Assistance Publique-Hôpitaux de Paris, Creteil, France.
| | | |
Collapse
|
35
|
Weber M. The Importance of Exercise for Individuals with Chronic Mental Illness. J Psychosoc Nurs Ment Health Serv 2010; 48:35-40. [DOI: 10.3928/02793695-20100831-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 06/15/2010] [Indexed: 11/20/2022]
|
36
|
Staging perspectives in neurodevelopmental aspects of neuropsychiatry: agents, phases and ages at expression. Neurotox Res 2010; 18:287-305. [PMID: 20237881 DOI: 10.1007/s12640-010-9162-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 02/08/2010] [Accepted: 02/08/2010] [Indexed: 12/24/2022]
Abstract
Neurodevelopmental risk factors have assumed a critical role in prevailing notions concerning the etiopathogenesis of neuropsychiatric disorders. Staging, diagnostic elements at which phase of disease is determined, provides a means of conceptualizing the degree and extent of factors affecting brain development trajectories, but is concurrently specified through the particular interactions of genes and environment unique to each individual case. For present purposes, staging perspectives in neurodevelopmental aspects of the disease processes are considered from conditions giving rise to neurodevelopmental staging in affective states, adolescence, dopamine disease states, and autism spectrum disorders. Three major aspects influencing the eventual course of individual developmental trajectories appear to possess an essential determinant influence upon outcome: (i) the type of agent that interferes with brain development, whether chemical, immune system activating or absent (anoxia/hypoxia), (ii) the phase of brain development at which the agent exerts disruption, whether prenatal, postnatal, or adolescent, and (iii) the age of expression of structural and functional abnormalities. Clinical staging may be assumed at any or each developmental phase. The present perspective offers both a challenge to bring further order to diagnosis, intervention, and prognosis and a statement regarding the extreme complexities and interwoven intricacies of epigenetic factors, biomarkers, and neurobehavioral entities that aggravate currents notions of the neuropsychiatric disorders.
Collapse
|