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Fysiotherapie bij mensen met schizofrenie. Een literatuuronderzoek
Schizofrenie kenmerkt zich door psychotische perioden met positieve symp-tomen zoals wanen, hallucinaties en verwardheid en geassocieerde klachten zoals angst, achterdocht en opwinding. De psychotische perioden worden afgewisseld met remissieperioden waarin sprake is van enig, soms aanzien-lijk, herstel, maar ook van het optreden van negatieve symptomen zoals psy-chomotorische vertraging, snelle mentale uitputting, cognitieve stoornissen en vervlakking van het gevoelsleven. Schizofrenie staat op de vijfde plaats wanneer het aankomt op het aantal gezonde levensjaren dat een persoon verliest ten gevolge van de ziekte (Wereldgezondheidsorganisatie, 2008).
Background: Recent United Kingdom Government Policy documents have emphasized the need to improve the physical health of patients with mental illness. Although physical health could be improved by increasing physical activity levels, uptake of widely available community-based activity programmes is low in this patient population. Aims: To investigate the barriers to uptake of and adherence to physical activity in community-dwelling patients with a diagnosis of schizophrenia. Methods: Qualitative study on 27 community dwelling patients with a diagnosis of schizophrenia from four Community Mental Health Teams (CMHT) in Edinburgh. Patients were individually interviewed using a semi-structured questionnaire. Themes and sub themes from the interviews were identified using Interpretive Phenomenological Analysis (IPA). Results: Four barriers to physical activity uptake were identified: limited experience of physical activity engagement, impact of the illness and effects of medication, effects of anxiety and the influences of support networks. Conclusion: These patients experience complex barriers to physical activity uptake which need to be considered in the design of physical activity interventions to target obesity and related physical health problems.
The purpose of this study was to examine the effects of 10 weeks of physical exercises programme on mental states and quality of life (QOL) of individuals with schizophrenia. The study involved 30 inpatients or outpatients with schizophrenia who were assigned randomly into aerobic exercise (n = 15) group and control (n = 15) group, participated to the study voluntarily. There were no personal differences such as age, gender, disorder duration, medication use between the both groups. An aerobic exercise programme was applied to the subject group, the periods of 10 weeks as 3 days in a week. Data were collected by using the Brief Symptom Inventory, the Scale for the Assessment of Positive Symptoms, the Scale for the Assessment of Negative Symptoms and to the both group before and after the exercise programme. After the 10-week aerobic exercise programmes the subjects in the exercise programme showed significantly decreases in the Scale for the Assessment of Positive Symptoms, the Scale for the Assessment of Negative Symptoms and the Brief Symptom Inventory points and their World Health Organization Quality of Life Scale-Turkish Version points were increased than controls. These results suggest that mild to moderate aerobic exercise is an effective programme for decreasing psychiatric symptoms and for increasing QOL in patients with schizophrenia.
Studies have suggested a possible role for shiatsu in treating a variety of mental and physical ailments.
To determine if shiatsu can provide clinical benefit to individuals diagnosed with schizophrenia.
An open-label pilot study.
An inpatient psychiatric ward at Herzog Memorial Hospital, Jerusalem, Israel.
Twelve hospitalized patients with chronic schizophrenia.
Shiatsu treatment provided in a course of eight 40-minute biweekly sessions over 4 weeks.
All subjects were evaluated at baseline, 2 weeks, 4 weeks (end of treatment), and 12 weeks (followup). The tools used for assessment included the Clinical Global Impression (CGI), the Brief Psychiatric Rating Scale (BPRS), the Positive and Negative Syndrome Scale (PANSS), the Hamilton Rating Scale for Depression (HAM-D), the Hamilton Anxiety Rating Scale (HAM-A), and the Nurses' Observation Scale for Inpatient Evaluation (NOSIE). Side effects were measured using the Simpson-Angus Scale for Extrapyramidal Symptoms (SAS) and the Abnormal Involuntary Movement Scale (AIMS).
On all scales of psychopathology and side effects, the subjects showed a statistically and clinically significant improvement by the end of treatment. This improvement was maintained at the 12-week follow-up. These findings, while encouraging, must be considered preliminary and require confirmation and cross-validation in larger-scale controlled studies.
This article presents evidence suggesting that psychosocial stress may increase risk for psychosis, especially in the case of cumulative exposure. A heuristically useful framework to study the underlying mechanisms is the concept of "behavioral sensitization" that stipulates that exposure to psychosocial stress--such as life events, childhood trauma, or discriminatory experiences--may progressively increase the behavioral and biological response to subsequent exposures. The neurobiological substrate of sensitization may involve dysregulation of the hypothalamus-pituitary-adrenal axis, contributing to a hypothesized final common pathway of dopamine sensitization in mesolimbic areas and increased stress-induced striatal dopamine release. It is argued that, in order to reconcile genetic and environmental influences on the development of psychosis, gene-environment interactions may be an important mechanism in explaining between-subject differences in risk following (cumulative) exposure to psychosocial stress. To date, most studies suggestive of gene-stress interaction have used proxy measures for genetic vulnerability such as a family history of psychosis; studies investigating interactions between molecular genetic measures and psychosocial stressors are still relatively scarce. Preliminary evidence suggests that polymorphisms within the catechol-O-methyltransferase and brain-derived neurotrophic factor genes may interact with psychosocial stress in the development of psychosis; however, extensive further investigations are required to confirm this.
Delusions relating to the body, a ready source of information about the immediate experiences of psychotic patients, have not been systematically studied. We attempted an account of the phenomena, looking for differences between diagnostic groupings in the type and lateralisation of such phenomena, and for evidence of localisation.
Somatic delusions elicited at interview with 550 Research Diagnostic Criteria-diagnosed psychotic patients were categorised according to content, and the results were compared across diagnostic groupings.
Significant differences were demonstrated, both at the level of individual delusions and in the nature and overall pattern of such delusions. There were also differences between diagnostic groups in the choice of body parts involved. Among male patients there were significant differences in laterality between the groups, with schizophrenic subjects locating abnormal phenomena principally on the left and depressive subjects on the right. A provisional taxonomy of bodily delusions was developed.
Phenomenological differences between the psychoses were demonstrated and the results offer some support for current hypotheses of localisation of brain dysfunction in the psychotic illnesses.
More than 20 studies of schizophrenia have found a three-factor model of symptom complexes or syndromes consisting of hallucinations/delusions, disorganization of thought and behavior, and negative symptoms. Several lines of evidence suggest that these syndromes relate to neurobiological differences. We examined the relationship of these three syndromes to neurological signs.
The relationships among the subscales of the Neurological Evaluation Scale and hallucinations/delusions, disorganization, and the deficit syndrome were examined in 83 clinically stable outpatients with schizophrenia. Patients with the deficit syndrome have enduring, idiopathic (or primary) negative symptoms.
Each of the three syndromes had a distinctive pattern of relationships to neurological signs. Disorganization was significantly related to the total score on the Neurological Evaluation Scale, to sensory integration, and to the sequencing of complex motor acts. The deficit syndrome was significantly related to sensory integration only. Neither hallucinations/delusions nor a continuous measure of negative symptoms derived from the Brief Psychiatric Rating Scale (that measured both primary and secondary negative symptoms, as well as enduring and transient symptoms) was related to any of the Neurological Evaluation Scale subscales or total score. Drug treatment was not related to neurological impairment.
The results further support the neurobiological significance of the three clinical syndromes of schizophrenia. Ratings on a scale measuring negative symptoms appear to be less sensitive to neurobiological correlates than is the categorization of the presence or absence of the deficit syndrome.
While the benefits of physical fitness have been extensively documented, there is a paucity of literature examining the impact of an exercise program on people experiencing a mental illness. An exploratory study was conducted with six patients diagnosed with schizophrenia who participated in a 3-month physical conditioning program. The findings suggest that most participants increased their physical strength and endurance and exhibited improvements in weight control and flexibility. The majority of patients reported increased fitness levels, exercise tolerance, reduced blood pressure levels, perceived energy levels and upper body and hand grip strength levels.
p>Despite evidence that individuals with schizophrenia spectrum disorders experience significant and persistent symptoms of anxiety, there are few reports of the use of empirically supported treatments for anxiety in this population. This article describes how we have tried to adapt mindfulness interventions to help individuals with schizophrenia who experience significant anxiety symptoms. Although mindfulness has been widely used to help individuals without psychosis, to our knowledge, this is the first study adapting it to help those with schizophrenia manage worry and stress. We provide an overview of the intervention and use an individual example to describe how our treatment development group responded. We also explore directions for future research of mindfulness interventions for schizophrenia.
Dr. Davis is a Research Clinical Psychologist, and Ms. Strasburger is Program Specialist, Psychiatry Research, Roudebush VA Medical Center, and Ms. Brown is a graduate student, Department of Clinical Rehabilitation Psychology, Indiana Purdue University, Indianapolis, Indiana.
The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support.
Address correspondence to Louanne W. Davis, PsyD, Research Clinical Psychologist, Roudebush VA Medical Center, Psychiatry Research 116A, 1431 West 10th Street, Indianapolis, IN 46202; e-mail: louanne.davis@va.gov . </p
Background and Purpose: To explore the experiences of patients undergoing basic body awareness therapy in psychiatric physiotherapy. In addition, the therapeutic relationship and the concept of the working alliance were examined. Subjects: Two groups of patients participated: patients with schizophrenia (n=6) and general psychiatric outpatients (n=5). Method: A qualitative technique, video taping and interviewing the patients during treatment was used. Results: The most common experience from the treatment was ‘balance and posture’. Other experiences were ‘body movement control’ and ‘awareness and handling of body signals’. Themes central to establishing a good working alliance were identified. Discussion and Conclusions: The impact of balance and posture was discussed and some new hypotheses were generated.
Cannabis and comorbidity; cognitive remediation and clozapine; glycine and gliosis; prenatal exposures and paternal age; receptors and recovery; prodrome and phospholipids; urbanicity and unemployment—these and many other topics are covered in The American Psychiatric Publishing Textbook of Schizophrenia, in 23 chapters by 59 carefully selected experts. In their preface, the editors write, “There are many books about schizophrenia. . . . However, we felt that a textbook that encompassed the current state of knowledge of its cause, nature, treatment, and services was lacking and badly needed.”
PurposePeople with schizophrenia/schizoaffective disorders have a higher risk of morbidity and premature mortality compared to the general population in part due to sedentary lifestyles. The aim of this pilot study was to investigate the feasibility and effects of aerobic (AT) and resistance training (RT) on individuals with schizophrenia/schizoaffective disorders.
Objectives: To identify and evaluate the recent evidence of physical activity (PA) with or without diet counselling on cardiometabolic parameters in people who have schizophrenia.
Methods: Keyword searches were used to identify articles since 2003 up to August 2009 from PubMed, SPORTDiscus, Cochrane Central Register of Controlled Trials, EMBASE, PEDro, DARE, ProQuest Dissertations and Theses and PsycINFO. There were no limitations in terms of study design and sample size. Data were extracted from each included study using key items that included participants, study design, intervention modalities, and outcome measures.
Results: Thirteen studies met the inclusion criteria. Physical activity with or without diet counselling results in modest weight loss, reductions in systolic and diastolic blood pressure and decreases in fasting plasma concentrations of glucose and insulin. Identifying an optimal dose or intervention strategy for PA is not yet possible. Compliance to PA seems to be an important predictor of the PA response.
Discussion: There is evidence that PA with or without diet counselling is feasible and effective in reducing weight and improving obesity-related cardiometabolic risk profile in people with schizophrenia. More research focussing on the effectiveness of different PA interventions in prevention and treatment of the metabolic syndrome in people with schizophrenia is highly needed.
Previous reviews of the exercise and mental health literature have predominantly examined non-clinical populations and clinical populations with anxiety and/or depressive disorders. There is growing, albeit limited, evidence that exercise can also be an effective adjunctive treatment for other clinical disorders such as alcohol abuse, somatoform disorders and psychosis. This review examines the literature that has investigated the use of exercise as an adjunct treatment for schizophrenia. While methodological concerns are evident in the literature, attention is drawn to the difficulties of assessing traditional exercise interventions with such a population and the need for greater acceptance of methodological diversity. The existing research indicates that exercise is a useful adjunct for some of the negative symptoms of schizophrenia in addition to depression and anxiety. Additionally, the use of exercise as a coping strategy for positive symptoms, such as auditory hallucinations, has been suggested. Mechanisms underpinning such benefits, the exercise 'dosage' and issues of adherence are discussed.
A practical guide to doing effective and efficient searches for relevant literature.
The treatment of mental illness presents an opportunity to examine the heterogeneity of treatment effects. The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial was sponsored by the National Institute of Mental Health (NIMH) to evaluate the effectiveness of antipsychotic medications for schizophrenia in broad patient populations and in scenarios representative of standard clinical practice. Trial inclusion criteria were broad and exclusion criteria were minimal, allowing for a heterogeneous study population. The majority of patients in each phase 1 treatment group discontinued their randomly assigned treatment owing to inadequate efficacy, intolerable side effects, or other reasons. Phase 2 of CATIE featured 2 treatment pathways (efficacy and tolerability) with randomized follow-up medication based on the reason for discontinuation of the previous antipsychotic drug. Outcome differences between treatment groups and variable responses to medications across the study suggest why multiple medication trials are common and may be necessary in the treatment of schizophrenia. Collectively, the CATIE results highlight variable response in the treatment of schizophrenia and demonstrate the need for individualized therapy based on variations in drug efficacy and tolerability among patients.
The objective of this study was to examine the efficacy of progressive muscle relaxation training on anxiety in patients with acute schizophrenia.
Many empirical studies have found progressive muscle relaxation training beneficial in reducing the psychological effects of anxiety. Progressive muscle relaxation training is also effective in reducing the distress symptoms associated with the symptomatology of schizophrenia.
An experimental randomised controlled trial using repeated measures.
The study was designed to examine the effects of progressive muscle relaxation training on patients diagnosed with schizophrenia. Study participants were acute psychiatric inpatients in Taiwan. Eighteen patients were block randomised and then assigned to an experimental or control group. The experimental group received progressive muscle relaxation training and the control group received a placebo intervention. Results from the Beck anxiety inventory were compared between groups as a pretest before intervention, on day 11 of intervention and one week post-test after the intervention was completed. Changes in finger temperature were measured throughout the experiment.
The degree of anxiety improvement was significantly higher in the progressive muscle relaxation training group than in the control group after progressive muscle relaxation training intervention (p < 0.0001) and at follow-up (p = 0.0446; the mean BAI score fell from 16.4 pretest to -5.8 post-test. After adjusting for the change in patient finger temperature, the mean change in temperature was significantly different between the two patient groups. The average body temperature increased significantly after applying the progressive muscle relaxation training to patients with schizophrenia.
This study demonstrated that progressive muscle relaxation training can effectively alleviate anxiety in patients with schizophrenia.
Progressive muscle relaxation training is potentially an effective nursing intervention in the reduction of anxiety in patients diagnosed with schizophrenia, depending on the quality of their mental status at the time of intervention. Progressive muscle relaxation training is a useful intervention as it is proven to reduce anxiety levels across a spectrum of psychiatric disorders.
Metabolic syndrome and other cardiovascular risk factors are highly prevalent in people with schizophrenia. Patients are at risk for premature mortality and overall have limited access to physical health care. In part these cardio-metabolic risk factors are attributable to unhealthy lifestyle, including poor diet and sedentary behaviour. But over recent years it has become apparent that antipsychotic agents can have a negative impact on some of the modifiable risk factors. The psychiatrist needs to be aware of the potential metabolic side effects of antipsychotic medication and to include them in the risk/benefit assessment when choosing a specific antipsychotic. He should also be responsible for the implementation of the necessary screening assessments and referral for treatment of any physical illness. Multidisciplinary assessment of psychiatric and medical conditions is needed. The somatic treatments offered to people with severe and enduring mental illness should be at par with general health care in the non-psychiatrically ill population.
The voluntary motor disturbances found among many schizophrenic patients consist of motor incoordination, disturbed pursuit tracking, difficulty following movement sequences, desynchronized tapping, and a myriad of neurologic soft signs. The problem with many of these observations is that it is extremely difficult to distinguish movement disorders related to neuroleptic treatment from those that may have occurred spontaneously. The aim of the present study was to examine potential disturbances in the voluntary control of steady-state force in neuroleptic-naive schizophrenic patients and normal comparison subjects. Twenty-one patients and 21 age- and gender-matched comparison subjects were studied. Spectral analyses of hand force instability revealed a significant difference between patients and comparison subjects. In 52 of the patients, the disturbance in the control of force exceeded the 95th percentile of the comparison mean. Degree of force instability was correlated with positive but not negative symptoms of schizophrenia. These findings suggest that schizophrenic patients may exhibit a disturbance in the control of muscle force that cannot be attributed to the neuroleptic effects of antipsychotic medication. The pattern of disruption, characterized by abnormal spectral energy within the 1.5 to 3.0 Hz range, suggests a motor disturbance that resembles tardive dyskinesia. Implicit within these findings of neuroleptic naive patients is the possibility that disturbances in the control of isometric force may represent spontaneous dyskinesia.
Despite a wide phenomenological interest in body image pathology in schizophrenia, there has been little systematic empirical research. This study aimed at establishing the specificity of body image pathology in patients with schizophrenia, its changes during acute treatment, and its association with other symptom factors. Cognitive (thoughts/beliefs regarding the body--body concept), affective (body satisfaction--body cathexis) and perceptual (body size estimation--body schema) facets of body image and psychopathology were assessed in in-patients with paranoid schizophrenia (N = 60), schizoaffective disorder (N = 19), depressive disorder (N = 40) and anxiety disorder (N = 28) at admission, and after 2 and 4 weeks of treatment. Body size perception was also assessed in a sample of healthy subjects (N = 44). Patients with paranoid schizophrenia/schizoaffective disorder showed under-estimation of lower extremities at each time point. They expressed a higher degree of body concept disturbances at admission, but not at later stages. In a factor analysis, body perception and body concept loaded on distinct factors, which were separate from positive symptoms, negative symptoms, and anxiety. Patients with acute paranoid schizophrenia and schizoaffective disorder seem to have a specific and consistent disturbance of body size perception, which might indicate a dysfunction of sensory information processing.
In excess of 55% of adults in the United States are classified as either overweight (body mass index = 25-29.9 kg.m(-2)) or obese (body mass index > or = 30 kg.m(-2)). To address this significant public health problem, the American College of Sports Medicine recommends that the combination of reductions in energy intake and increases in energy expenditure, through structured exercise and other forms of physical activity, be a component of weight loss intervention programs. An energy deficit of 500-1000 kcal.d-1 achieved through reductions in total energy intake is recommended. Moreover, it appears that reducing dietary fat intake to <30% of total energy intake may facilitate weight loss by reducing total energy intake. Although there may be advantages to modifying protein and carbohydrate intake, the optimal doses of these macronutritents for weight loss have not been determined. Significant health benefits can be recognized with participation in a minimum of 150 min (2.5 h) of moderate intensity exercise per week, and overweight and obese adults should progressively increase to this initial exercise goal. However, there may be advantages to progressively increasing exercise to 200-300 min (3.3-5 h) of exercise per week, as recent scientific evidence indicates that this level of exercise facilitates the long-term maintenance of weight loss. The addition of resistance exercise to a weight loss intervention will increase strength and function but may not attenuate the loss of fat-free mass typically observed with reductions in total energy intake and loss of body weight. When medically indicated, pharmacotherapy may be used for weight loss, but pharmacotherapy appears to be most effective when used in combination with modifications of both eating and exercise behaviors. The American College of Sports Medicine recommends that the strategies outlined in this position paper be incorporated into interventions targeting weight loss and the prevention of weight regain for adults.
Historically, schizophrenics' body image problems were regarded as related particularly to delusions and hallucinations. However, during the 1980s, the predominant view of the phenomenology of the disorder broadened to include negative symptoms; deviations in schizophrenics' body image underlie various behaviors or allegations concerning the body and should be refocused. The present study attempted to detect body image deviations in chronic schizophrenia using the Body Image Questionnaire (BIQ), which comprises three hypothetical components (anatomical, functional and other psychological components), and to clarify their related clinical characteristics in symptoms and insight. The BIQ was administered to 93 chronic schizophrenics (diagnosed according to DSM IV; 44 men and 49 women) and 177 normals (78 men and 99 women) adults. The combined data of the three BIQ components in schizophrenic and normal subjects were factor-analyzed separately, and factor scores obtained were compared between schizophrenic and normal groups. The factor scores that differentiated groups were further compared between schizophrenic subgroups, determined by high or low scores for positive symptoms assessed by Scale for the Assessment of Positive Symptoms, negative symptoms by Scale for the Assessment of Negative Symptoms and insight by the Schedule for Assessing Insight. Significant differences between diagnostic groups were found in five of nine factor scores. Dullness in movement, powerlessness, unusually strong gastrointestinal function, lifelessness and fragility proved to be the deviated body images in chronic schizophrenic patients. Powerlessness and lifelessness proved to be related to positive and negative symptoms, and unusually strong gastrointestinal function and fragility to insight.
This paper reports a systematic review of the published and grey literature which has investigated the efficacy of healthy living interventions for adults with a diagnosis of schizophrenia or schizo-affective disorder.
Adults with a diagnosis of schizophrenia or schizo-affective disorder have reduced life expectancy when compared with members of the general population, with approximately 59% of excess mortality resulting from natural causes.
The review was conducted following guidelines provided by the United Kingdom National Health Service Centre for Reviews and Dissemination, and using the Medline, PsycINFO, CINAHL, Embase, Cochrane Library, National Research Register, and System for Info on Grey Literature databases.
Sixteen studies were identified, examining four types of healthy living interventions: smoking cessation (n = 7), weight management (n = 5), exercise (n = 3) and nutritional education (n = 1). The smoking cessation, weight management and exercise studies showed positive outcomes in the main. The quality of the studies, however, was generally poor. Only two had control groups, most recruited small self-selected samples, six did not standardize for diagnosis, external validity was generally poor and no studies followed participants for longer than 6 months. The best quality evidence was produced by the smoking cessation and weight management studies, which were more methodologically robust and demonstrated promising outcomes.
Further research is needed to assist the development of effective interventions to help this client group to adopt and maintain healthier lifestyles. Research and practice development in this area may be an important role for nurses in both hospital and community settings.
This study evaluated the gait patterns of schizophrenic patients at free gait and at three fixed velocities on a treadmill. The effects of illness and antipsychotic treatment on gait parameters and on adaptation to treadmill walking were compared. Gait parameters of 14 drug-naive schizophrenic patients, 14 patients treated with conventional antipsychotics, 14 patients treated with olanzapine, as well as 14 matched controls were assessed on a walkway and on a treadmill at three different velocities (very slow, intermediately slow, and comfortable) using an ultrasonic movement analysis system. At free gait, all patients showed a significantly decreased gait velocity, predominantly due to a shorter stride length, when compared to the controls, with the most striking difference observed between the patients treated with conventional neuroleptics and the controls (ANOVA, P < or = 0.001). Cadence (steps per second) did not differ between the investigated groups. When gait was evaluated on the treadmill, differences in stride length and cadence were significant only at the very slow treadmill velocity (ANOVA, P < or = 0.05). In all patient groups, mean stride length was decreased and cadence compensationally increased. Significant differences between the patient groups were no longer detectable. With increasing treadmill velocities, gait parameters of all patient groups normalized. The results show that, like in patients with Parkinson's Disease, impaired gait parameters can also be normalized in schizophrenic patients by external stimulation via treadmill walking.
Although the benefits of exercise are well documented, few published research studies have examined exercise in persons with schizophrenia. This pilot examined a 16-week walking program for outpatients diagnosed with schizophrenia (N = 10). Six-minute walking distance, body mass index, percent body fat and severity of psychiatric symptoms were measured. Experimental participants in the walking group experienced significant reductions in body fat (p = 0.03) compared to a control group not participating in the exercises during the same time period. Experimental participants also had greater aerobic fitness, lower body mass indexes, and fewer psychiatric symptoms than controls at the conclusion of the program. Research is needed to identify effective exercise interventions and feasible delivery modalities for persons with schizophrenia in community settings.
The relationship between regular exercise and physical health and well-being is extensively documented in the literature. However, considerably less attention is devoted to the impact of exercise on health outcomes for people experiencing a mental illness. In response to the recognized paucity, a structured exercise program was developed and implemented for residents of a Community Care Unit in metropolitan Melbourne, Australia. Six residents participated in the program over a period of three months. This paper reports the findings of a qualitative study. A focus group interview was conducted with the resident participants (n=6), the exercise physiologists who developed and implemented the program (n=2), and nursing staff involved in implementing and supporting the program (n=4). Analysis of the data collected revealed that four main themes had emerged: the individual nature of the program, physical improvement, group dynamics, and future plans. The findings of this study suggest that involvement in the program produced very positive outcomes, most notably in the physical fitness of residents. The individual nature of the program which enabled gradual participation, and the cohesive approach of the group as a whole were considered very important factors contributing to the overall success. Furthermore, the participants planned to continue with some form of physical activity in the future. The potential value of regular exercise for patients experiencing a mental illness has significant implications for nursing and requires further research exploration.
Increasing physical activity must be one component of lifestyle interventions designed to prevent or treat obesity in schizophrenia and there is now a need to develop low cost, practical and accurate measures of physical activity in this population to identify the prevalence of physical (in)activity and to assess the effectiveness of physical activity interventions. The objective of this study was to provide preliminary validation of the Short-Form International Physical Activity Questionnaire (IPAQ), a measurement tool that could prove useful for both clinicians and researchers in the field.
Reliability and validity data were collected from a sample of 35 outpatients with a DSM-IV diagnosis of schizophrenia. Test-retest repeatability was assessed within the same week and criterion validity was assessed against an RT3 accelerometer. Spearman's correlation coefficients are reported based on the total reported physical activity (minutes) and estimated energy expenditure.
We found a correlation coefficient of 0.68 for reliability and 0.37 for criterion validity based on total reported minutes of physical activity. There was a nonsignificant correlation (0.30; p>0.05) between the RT3 data and estimated energy expenditure derived from the IPAQ.
Although not without limitations, the Short-Form IPAQ, when used with individuals with schizophrenia, exhibits measurement properties that are comparable to those reported in the general population and can be considered as a surveillance tool to assess levels of physical activity.
Metabolic abnormalities and weight gain are an important problem in patients with schizophrenia. An instrument to evaluate body image and self-esteem related to weight has recently been developed (B-WISE). The first objective was to evaluate whether the findings of the original validation study could be confirmed in a European sample. The second objective was to explore the association of B-WISE scores with the metabolic syndrome and glucose abnormalities.
A Dutch translation of B-WISE was tested in a large sample of patients with schizophrenia (n=300) who underwent an extensive metabolic screening.
The original findings with B-WISE were confirmed in an independent sample. Scores on B-WISE differed significantly as a function of BMI. Scores on B-WISE also differentiated patients with and without the metabolic syndrome and glucose abnormalities. Patients experiencing a recent weight gain had lower self-esteem and poorer psychosocial adaptation.
B-WISE could be a useful instrument to evaluate the subjective psychosocial consequences associated with current weight and weight gain in patients with schizophrenia.
Schizophrenia is associated with several chronic medical illnesses and a reduced life expectancy. This paper summarizes findings and recommendations from "The Mount Sinai Conference," held at the Mount Sinai School of Medicine in New York on October 17-18, 2002, and discusses the implications for improving medical monitoring of patients with schizophrenia who are managed in outpatient settings from the initiation of treatment. The Mount Sinai Conference involved a diverse panel of experts, including specialists on schizophrenia, obesity, diabetes, cardiology, endocrinology, and ophthalmology. Consensus recommendations included baseline measurement and regular monitoring of body mass index, blood glucose, lipid profiles, signs of prolactin elevation or sexual dysfunction, and movement disorders. Information from such measurements should be considered when selecting or switching antipsychotic agents and should trigger an evaluation of medication when abnormalities are detected.
Around half of all patients with schizophrenia are thought to abuse drugs or alcohol and there is good evidence to suggest that they have poorer outcomes than their non substance using counterparts. However, despite more than twenty years of research there is still no consensus on the aetiology of increased rates of substance use in people with psychosis. There is a clear need to understand the reasons for such high rates of substance use if treatments designed to help patients abstain from substance use are to be successful. This paper provides an update of the literature examining the reasons for substance use by people with psychosis, and includes a comprehensive review of the self report literature. The main theories as to why people with psychosis use substances are presented. There is evidence to suggest that cannabis may have a causal role in the development of psychopathology but not for other substances. The self report literature provides support for an 'alleviation of dysphoria' model of substance use but there is little empirical support for the self medication hypothesis, or for common factor models and bidirectional models of comorbidity. It is likely that there are multiple risk factors involved in substance use in psychosis and more work to develop and test multiple risk factor models is required.
To review the existing evidence examining effectiveness of exercise as an adjunct therapy for psychosis.
A search of databases including Pub Med, Psych Info, Cochrane Library, Cinahl, Sports Discus and Web of Knowledge was conducted to identify studies investigating the psychological changes following exercise interventions in people with psychosis. Literature was subjected to a critical review to determine the effectiveness of exercise as a therapy for psychosis.
A total of ten studies met the inclusion criteria: four quantitative, two qualitative and four using a mixed method design. Exercise interventions were supervised and generally lasted between 10 and 12 weeks. Study samples were small, even in the quantitative studies, meaning that statistical analysis was not always possible. Study design and outcome measures varied across all studies. Generally the research findings demonstrated a positive trend towards improved mental health for those participants utilising exercise.
The findings suggest the presence of a positive effect of exercise on mental health in people with psychosis, yet there is a need for greater consistency within the research to determine the size of effects and the most successful type of intervention. As exercise is increasingly used in the mental health service, more research is needed to provide a more comprehensive evidence-based practice.
Treatment of schizophrenia has remained unsatisfactory despite the availability of antipsychotics. This study examined the efficacy of yoga therapy (YT) as an add-on treatment to the ongoing antipsychotic treatment.
Sixty-one moderately ill schizophrenia patients were randomly assigned to YT (n = 31) and physical exercise therapy (PT; n = 30) for 4 months. They were assessed at baseline and 4 months after the start of intervention, by a rater who was blind to their group status.
Forty-one subjects (YT = 21; PT = 20) were available at the end of 4 months for assessment. Subjects in the YT group had significantly less psychopathology than those in the PT group at the end of 4 months. They also had significantly greater social and occupational functioning and quality of life.
Both non-pharmacological interventions contribute to reduction in symptoms, with YT having better efficacy.
Despite improvements in mental health services in recent decades, it is unclear whether the risk of mortality in schizophrenia has changed over time.
To explore the distribution of standardized mortality ratios (SMRs) for people with schizophrenia.
Broad search terms were used in MEDLINE, PsychINFO, Web of Science, and Google Scholar to identify all studies that investigated mortality in schizophrenia, published between January 1, 1980, and January 31, 2006. References were also identified from review articles, reference lists, and communication with authors.
Population-based studies that reported primary data on deaths in people with schizophrenia.
Operationalized criteria were used to extract key study features and mortality data.
We examined the distribution of SMRs and pooled selected estimates using random-effects meta-analysis. We identified 37 articles drawn from 25 different nations. The median SMR for all persons for all-cause mortality was 2.58 (10%-90% quantile, 1.18-5.76), with a corresponding random-effects pooled SMR of 2.50 (95% confidence interval, 2.18-2.43). No sex difference was detected. Suicide was associated with the highest SMR (12.86); however, most of the major causes-of-death categories were found to be elevated in people with schizophrenia. The SMRs for all-cause mortality have increased during recent decades (P = .03).
With respect to mortality, a substantial gap exists between the health of people with schizophrenia and the general community. This differential mortality gap has worsened in recent decades. In light of the potential for second-generation antipsychotic medications to further adversely influence mortality rates in the decades to come, optimizing the general health of people with schizophrenia warrants urgent attention.
The lifespan of people with schizophrenia is shortened compared to the general population. We reviewed the literature on comorbid physical diseases in schizophrenia to provide a basis for initiatives to fight this unacceptable situation.
We searched MEDLINE (1966 - May 2006) combining the MeSH term of schizophrenia with the 23 MeSH terms of general physical disease categories to identify relevant epidemiological studies.
A total of 44 202 abstracts were screened. People with schizophrenia have higher prevalences of HIV infection and hepatitis, osteoporosis, altered pain sensitivity, sexual dysfunction, obstetric complications, cardiovascular diseases, overweight, diabetes, dental problems, and polydipsia than the general population. Rheumatoid arthritis and cancer may occur less frequently than in the general population. Eighty-six per cent of the studies came from industrialized countries limiting the generalizability of the findings.
The increased frequency of physical diseases in schizophrenia might be on account of factors related to schizophrenia and its treatment, but undoubtedly also results from the unsatisfactory organization of health services, from the attitudes of medical doctors, and the social stigma ascribed to the schizophrenic patients.
Obesity in severely mentally ill (SMI) populations is an increasing problem, but there is no controlled data regarding the relationship between SMI and weight perception.
Fifty patients with schizophrenia and 50 demographically matched control participants were recruited. Weight, height, and body image accuracy were assessed for all participants, and assessments of mood, psychotic symptom severity and anxiety, and preferred modes of weight loss were assessed for the schizophrenia sample.
Patients with schizophrenia were significantly more likely to be obese than controls (46% vs. 18%, P < 0.005), and most patients expressed an interest in losing weight. Obese participants with schizophrenia underestimated their body size (11.0%) more than controls (4.9%) (P < 0.05).
Patients with schizophrenia are more likely to underestimate their body size, independent of the effects of obesity. However, they also express concern about weight issues and willingness to participate in psychoeducational groups targeted at weight loss.
Although we have studied schizophrenia as a major disease entity over the past century, its causes and pathogenesis remain obscure. In this article, we critically review genetic and other epidemiological findings and discuss the insights they provide into the causes of schizophrenia. The annual incidence of schizophrenia averages 15 per 100,000, the point prevalence averages approximately 4.5 per population of 1000, and the risk of developing the illness over one's lifetime averages 0.7%. Schizophrenia runs in families and there are significant variations in the incidence of schizophrenia, with urbanicity, male gender, and a history of migration being associated with a higher risk for developing the illness. Genetic factors and gene-environment interactions together contribute over 80% of the liability for developing schizophrenia and a number of chromosomal regions and genes have been "linked" to the risk for developing the disease. Despite intensive research and spectacular advances in molecular biology, however, no single gene variation has been consistently associated with a greater likelihood of developing the illness and the precise nature of the genetic contribution remains obscure at this time. Environmental factors linked to a higher likelihood of developing schizophrenia include cannabis use, prenatal infection or malnutrition, perinatal complications, and a history of winter birth; the exact relevance or nature of these contributions is, however, unclear. How various genetic and environmental factors interact to cause schizophrenia and via which precise neurobiological mechanisms they mediate this effect is not understood. Etiological heterogeneity, complex patterns of gene-gene and gene-environment interaction, and inadequately elucidated schizophrenia pathophysiology are among the explanations invoked to explain our inadequate understanding of the etio-pathogenesis of schizophrenia. The ability to question some of our basic assumptions about the etiology and nature of schizophrenia and greater rigor in its study appear critical to improving our understanding about its causation.
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