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Exercise for Mental Health

© C
2006 P
, I
. © C
2006 P
, I
Prim Care Companion J Clin Psychiatry 2006;8(2)106
Exercise for Mental Health
Sir: In this era of exponential growth of the “met-
abolic syndrome” and obesity, lifestyle modifications
could be a cost-effective way to improve health and qual-
ity of life. Lifestyle modifications can assume especially
great importance in individuals with serious mental ill-
ness. Many of these individuals are at a high risk of
chronic diseases associated with sedentary behavior and
medication side effects, including diabetes, hyperlipi-
demia, and cardiovascular disease.
An essential compo-
nent of lifestyle modification is exercise. The importance
of exercise is not adequately understood or appreciated
by patients and mental health professionals alike. Evi-
dence has suggested that exercise may be an often-
neglected intervention in mental health care.
Aerobic exercises, including jogging, swimming,
cycling, walking, gardening, and dancing, have been
proved to reduce anxiety and depression.
These im-
provements in mood are proposed to be caused by
exercise-induced increase in blood circulation to the
brain and by an influence on the hypothalamic-pituitary-
adrenal (HPA) axis and, thus, on the physiologic reac-
tivity to stress.
This physiologic influence is probably
mediated by the communication of the HPA axis with
several regions of the brain, including the limbic system,
which controls motivation and mood; the amygdala,
which generates fear in response to stress; and the hip-
pocampus, which plays an important part in memory for-
mation as well as in mood and motivation.
Other hypotheses that have been proposed to explain
the beneficial effects of physical activity on mental
health include distraction, self-efficacy, and social inter-
While structured group programs can be effective
for individuals with serious mental illness, lifestyle
changes that focus on the accumulation and increase of
moderate-intensity activity throughout the day may be
the most appropriate for most patients.
Interestingly, ad-
herence to physical activity interventions in psychiatric
patients appears to be comparable to that in the general
Exercise improves mental health by reducing anxiety,
depression, and negative mood and by improving self-
esteem and cognitive function.
Exercise has also been
found to alleviate symptoms such as low self-esteem and
social withdrawal.
Exercise is especially important in
patients with schizophrenia since these patients are al-
ready vulnerable to obesity and also because of the addi-
tional risk of weight gain associated with antipsychotic
treatment, especially with the atypical antipsychotics. Pa-
tients suffering from schizophrenia who participated in
a 3-month physical conditioning program showed im-
provements in weight control and reported increased fit-
ness levels, exercise tolerance, reduced blood pressure
levels, increased perceived energy levels, and increased
upper body and hand grip strength levels.
Thirty minutes
of exercise of moderate intensity, such as brisk walking
for 3 days a week, is sufficient for these health benefits.
Moreover, these 30 minutes need not to be continuous;
three 10-minute walks are believed to be as equally use-
ful as one 30-minute walk.
Health benefits from regular exercise that should be
emphasized and reinforced by every mental health pro-
fessional to their patients include the following:
1. Improved sleep
2. Increased interest in sex
3. Better endurance
4. Stress relief
5. Improvement in mood
6. Increased energy and stamina
7. Reduced tiredness that can increase mental alertness
8. Weight reduction
9. Reduced cholesterol and improved cardiovascular
Mental health service providers can thus provide effec-
tive, evidence-based physical activity interventions for in-
dividuals suffering from serious mental illness. Further
studies should be done to understand the impact of combin-
ing such interventions with traditional mental health treat-
ment including psychopharmacology and psychotherapy.
The authors report no financial or other affiliation relevant to
the subject of this letter.
1. Richardson CR, Faulkner G, McDevitt J, et al. Integrating
physical activity into mental health services for persons with
serious mental illness. Psychiatr Serv 2005;56:324–331
2. Callaghan P. Exercise: a neglected intervention in mental health
care? J Psychiatr Ment Health Nurs 2004;11:476–483
3. Guszkowska M. Effects of exercise on anxiety, depression and
mood [in Polish]. Psychiatr Pol 2004;38:611–620
4. Peluso MA, Andrade LH. Physical activity and mental health:
the association between exercise and mood. Clinics 2005;60:
5. Fogarty M, Happell B, Pinikahana J. The benefits of an
exercise program for people with schizophrenia: a pilot study.
Psychiatr Rehabil J 2004;28:173–176
Ashish Sharma, M.D.
University of Nebraska Medical Center
Vishal Madaan, M.D.
Creighton University/
University of Nebraska Medical Center
Frederick D. Petty, M.D., Ph.D.
Omaha VA Medical Center
Omaha, Nebraska
Citalopram Treatment for Inappropriate Sexual
Behavior in a Cognitively Impaired Patient
Sir: Sexual inappropriateness and hypersexuality can
be defined as vigorous sexual drive or other sexually
related problems that interfere with normal activities of
daily living, or sexual behavior that is pursued at inappro-
priate times. By definition, such behavior is persistent,
uninhibited, and directed against oneself or toward unwill-
ing partners. Inappropriate sexual behavior encompasses a
range of behavior, including suggestive language, flirta-
tion, fondling, removing one’s clothing, and masturbating
in public. The rates of sexual disinhibition reported in the
literature in people diagnosed with Alzheimers disease liv-
ing both in the community and in residential care range
from 2.9% to 8%.
These behaviors may result from mental
and physical illnesses, alone or in combination.
Work has been done as to how hospital and nursing
home staff should respond to these behaviors and guide
© C
2006 P
, I
. © C
2006 P
, I
Prim Care Companion J Clin Psychiatry 2006;8(2) 107
the development of management strategies and care plans. Most
researchers agree that behavioral, psychological, and environ-
mental interventions are preferable to the risks of pharmacol-
However, Harris and Wier,
in a review of the literature,
found that, in many cases, pharmacologic treatment is often
the preferred first-line treatment for hypersexual behavior be-
cause of its ease of administration, perceived efficacy, and de-
creased use of staff time. Numerous medications have been
tried for the treatment of such behaviors, but there are no con-
vincing data supporting the use of a particular medication. Be-
cause most evidence is in the form of case reports, data are also
lacking regarding the advantage of any medication over placebo
or in comparison with other medications.
Some preliminary reports indicate that selective serotonin
reuptake inhibitors (SSRIs) might be effective in controlling
such behaviors.
The reason for their effectiveness has yet
to be established, but the effectiveness could be due to their
antiobsessive and antilibidinal effects. To our knowledge, no
case reports have been published on the use of citalopram for
such behaviors. We report successful use of citalopram in the
treatment of inappropriate sexual behavior in a cognitively im-
paired adult with a history of bipolar disorder.
Case report. Mr. A, a 54-year-old man with a long history
of bipolar disorder and recent onset of cognitive deficits due to
Parkinson’s disease, had been displaying inappropriate sexual
behavior on and off for the last 5 years. This problem had re-
cently become worse and had necessitated multiple hospital ad-
missions. At the time of this admission, he was on a regimen
that included lamotrigine, clozapine, aripiprazole, ziprasidone,
and olanzapine. Once he was admitted, all of his psychotropic
medications except clozapine were stopped and lithium 150 mg
b.i.d. was initiated; after a few days, clozapine was stopped as
Mr. A continued to be disorganized and was making sexually
inappropriate comments and touching female staff members,
which progressed to making inappropriate comments toward
male peers and staff members. This behavior had not responded
to the numerous antipsychotic medications he was taking at the
time of this admission. Estrogen, which has been considered ef-
fective in reducing inappropriate sexual behavior, seemed only
to have attenuated this behavior and caused the patient to de-
velop gynecomastia, which was unacceptable to him and his
Mr. A was difficult to interview; he was disorganized and ex-
tremely distractible. During his lucid periods when he had more
insight, however, he would talk about thoughts of a sexual na-
ture that he was unable to get rid of despite identifying them as
improper. Neither could he control the urges to touch female
companions or make comments of a sexual nature.
After the behavior had been observed by the treatment team
for about a month, during which time trials to manage the
patient behaviorally had failed, treatment with citalopram
20 mg/day was started. Five days after the start of citalopram,
Mr. As inappropriate sexual behavior started to disappear. Two
weeks into therapy, although he remained somewhat disorga-
nized in his thoughts, the sexual inappropriateness had disap-
peared. No side effects were reported by the patient or noted by
the treatment team. There were no concomitant medication
In this case, we postulate that the sexually disinhibited be-
havior was caused by obsessive thoughts and resulted in com-
pulsive behavior. One can speculate that the beneficial effects
of SSRIs on these behaviors can at least partially be explained
by the effectiveness of this class of medications in treating
obsessive-compulsive spectrum disorders. Another possibility
is that, in some patients, SSRIs might have the side effect of di-
minishing libido. However, it has also been reported that SSRIs
cause disinhibition of libido.
Of note, this particular patient has Parkinson’s disease, a
frequent cause of such behavior. Interestingly in our case, such
behavior could not have been related to dopaminergic treatment
since no such treatment was used. This finding raises the pos-
sibility that some of the inappropriate sexual behavior that pa-
tients with Parkinson’s disease display is not the result of
dopaminergic drugs but rather may be a consequence of demen-
tia which itself often accompanies this disease.
SSRIs—in our case, citalopram—might be of use in treating
inappropriate sexual behavior. Controlled trials are needed to
establish the efficacy of these agents in treating such behavior.
If efficacy is established, further investigation to clarify why
these medications are so effective is warranted.
The authors report no financial or other affiliation relevant to the
subject of this letter.
1. Higgins A, Barker P, Begley CM. Hypersexuality and dementia:
dealing with inappropriate sexual expression. Br J Nurs 2004;13:
2. Lesser JM, Hughes SV, Jemelka JR, et al. Sexually inappropriate
behaviors: assessment necessitates careful medical and psychological
evaluation and sensitivity. Geriatrics 2005;60:34–37
3. Harris L, Wier M. Inappropriate sexual behaviour in dementia:
a review of the treatment literature. Sex Disabil 1998;16:205–217
4. Levitsky AM, Owens NJ. Pharmacologic treatment of hypersexuality
and paraphilias in nursing home residents. J Am Geriatr Soc 1999;
5. Lothstein LM, Fogg-Waberski J, Reynolds P. Risk management and
treatment of sexual disinhibition in geriatric patients. Conn Med
6. Greil W, Horvath A, Sassim N, et al. Disinhibition of libido:
an adverse effect of SSRI? J Affect Disord 2001;62:225–228
Irakli Mania, M.D.
Harun Evcimen, M.D.
Maju Mathews, M.D., M.R.C.Psych.
Department of Psychiatry
Drexel University College of Medicine
Philadelphia, Pennsylvania
... Physical activity is beneficial for a range of physical and mental health issues, including obesity, type II diabetes (Kumar et al., 2019), cancer (McTiernan et al., 2019), and mood and anxiety disorders (Chan et al., 2019), and has been shown to increase the human life span (Anderson and Durstine, 2019). Importantly, exercise produces a range of positive effects at the psychological level including decreased stress, anxiety, and fatigue, and improved energy, mood, self-esteem, and social satisfaction (Sharma et al., 2006;Basso and Suzuki, 2017;Mikkelsen et al., 2017). To date, the majority of research in this realm has focused on either aerobic (e.g., running) or anaerobic (e.g., weight lifting) exercise. ...
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... As well as providing physical benefits (Warburton, Nicol and Bredin 2006), exercise reduces anxiety and depression and improve mental health overall (Sharma, Madaan and Petty 2006). Police officers who were assigned to exercise three times a week for eight weeks showed large increases in well-being and quality of life measures compared to controls (Norris, Carroll and Cochrane 1990). ...
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First responders around the world suffer from high levels of burnout and other psychological symptoms related to their exposure to traumatic events. Psychological resilience is an important factor in mitigating the effects of this exposure, whereas the effects of spirituality/religiosity have not been clearly determined. The primary aim of this study was to determine the levels of work-related burnout and psychological resilience among first responders working in the City of Johannesburg. Furthermore, this study aimed to determine the levels of religiosity and spirituality in this population and their correlation with psychological resilience and work-related burnout. A non-experimental, cross-sectional, and criterion-group design was used. Firefighters, emergency medical technicians and disaster managers employed by the City of Johannesburg were identified using purposive sampling, eventually constituting a sample of 111 participants. The Copenhagen Burnout Inventory, the Brief Resilience Scale, the Duke University Religion scale and a biographical questionnaire were used to gather information from the participants. Stepwise regression analysis was done to determine the association between burnout, resilience and religiosity/spirituality. Results from the study showed that first responders had high levels of burnout and were not always able to access the help they required. Having attended stress management training correlated with higher resilience and lower burnout scores. For the sub-group of firefighters, higher levels of spirituality correlated with both increased resilience and lower burnout scores. Based on these findings, recommendations were made for increased mental health awareness, training and access to support structures for first responders. Keywords: First responder, Burnout, Spirituality, Psychological resilience, Johannesburg
... About 40% of female students in sporting schools reported the poor category and 60% in the very poor category whereas 100% of female students in non-sporting schools students fall very poor category. The poor physical fitness of the female student in both schools may be due to a lack of regular cardiovascular fitness, poor physical activity, improper nutritional status, family unwillingness in sports and physical activity, and a severe addiction to social media Regular physical activity is essential for physical and mental health [18] , and also physical activity helps to improve the motor cognition of individuals [19] . The benefits of physical activity to improve cardiovascular fitness is also well documented in the literature [20,21] . ...
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Aims: Childhood obesity is one of the leading causes of various musculoskeletal problems and health-related issues among school-going children. Regular sporting activity helps to maintain physical fitness. To compare the effects of physical activity on Body Mass Index (BMI) and cardiovascular endurance among the students of the sporting school and general school. Method and Materials: This pilot study was conducted among the students of the sporting school and general school from a selected area of Bangladesh. A total of 20 participants (10 from sporting schools and 10 from general schools) both males and females took part in this study. Anthropometric measurement was taken after getting consent from the participants. The Havard Step Test was used to collect data. Descriptive statistics and an independent t-test were used to compare the data. The p value was set at <0.05 as the level of significance. Findings: The mean age, height, weight, and BMI of the participants in the sporting group were 16.37±1.04 years, 117.72±12.01 cm, 64.25±25 kg, and 19.93±1.10 kg/m2 and in the non-sporting group were 14.65±0.93 years, 105.22±14.42 cm, 61.23±2.19 kg, and 19.64±2.27 kg/m2 respectively. There was no significant difference in BMI (p= 0.412) but cardiovascular endurance (p=0.026) showed a significant difference among sporting school and non-sporting school children. Conclusion: Though females in sporting schools have a high level of cardiovascular endurance results of both groups are not as expected. The study strongly recommended that every school should arrange competitive games at least once a week for their students.
... The physical fitness level influences physical health as well as mental and cognitive health. According to studies, regular physical exercise increases physical fitness and has a beneficial effect on mental health (Sharma, Vishal, & Frederick, 2006) and cognitive development (Hogan, Mata, & Carstensen, 89 2013). People with an optimal physical fitness level have an increased ability to concentrate as well as an improved short-term and long-term memory (Hillman, Castelli & Buck, 2005). ...
"Introduction. In 2013, the Cooper Institute from the U.S.A., along with the Hungarian School Sport Federation, implemented the National Student Fitness Test battery. In order to interpret the results, NETFIT uses a criterion-referenced standard depending on age and gender called the health standard, establishing the level of the subject in relation to certain objectives. This health standard corresponds to a minimal motor performance necessary to avoid certain risks of illnesses which may occur as a result of physical inactivity. The aim of this research is to determine the levels of health components of physical fitness among students in 1st year at Partium Christian University from Oradea, depending on their residential environment and gender. Material and methods. The research included a sample group of 112 students, aged 18 – 19 years. The health components of physical fitness were assessed by determining the adipose tissue level, two anthropometric measurements and 5 motor tests. Results. The registered data regarding the BMI values show that 13% of the students were overweight and 10% fell into the obese category. The female students with a low level of adipose tissue had significantly better results from statistical point of view at the standing broad jump test (rxy = - 0.42, df = 71, p < 0.001, rs = - 0.38, df = 71, p < 0.001). According to the data obtained at the motor tests, we found that at the standing broad jump test 49%, handgrip test 62.5%, paced curl-ups test 80%, flexibility test 64% and paced push-ups test 83% of the subjects fell within the healthy fitness zone. Conclusions. We consider that, in order to avoid risks due to insufficient physical activity, the level of biomotor potential of students must be related to their health. Not all students dream of performance and competitions, but they all want to be healthy! Keywords: health component, physical fitness, adipose tissue, student."
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Objective:- To correlate psychological changes with exercise. Methodology:- This cross-sectional study was conducted on 102 participants in a known Gym with age group 17-75 (28.3 +/- 10.4 , 70.59% males). They were given "Rosenberg self-esteem Questionnaire", "Satisfaction with life scale" & "Hamilton & Beck's Depression Inventory" in pen-paper type and were asked to fill it twice; once at the present time and once in retrospection before they started doing exercise. Three different values of Self-esteem, Satisfaction and Depression were collected. Answers from these Depression, Self-esteem questionnaire and Satisfaction questionnaire were summed up to get the final individual score. Results: - Overall gain was 62.53% suggesting positive impact of exercise. Highest impact was seen in age group of 17-30 of 72.46%. Lower education groups showed significantly higher gain, compared to higher educational groups (191.80%vs42.64%,p<0.05), which may be because of already higher scores in pre-exercise stage among higher education group. Target-achievers showed significantly higher gain compared to non-target-achievers (84.84%vs33.18%,p<0.01)). Conclusion: - Exercise has an overall positive impact on satisfaction, self-esteem and reduction in depression. People are influenced by different factors into getting fit and most of them agree that body image has a value in their perception of any individual.
While climate change and population ageing are expected to increase the exposure and vulnerability to extreme heat events, there is emerging evidence suggesting that social inequalities would additionally magnify the projected health impacts. However, limited evidence exists on how social determinants modify heat-related cardiovascular morbidity. This study aims to explore the association between heat and the incidence of first acute cardiovascular event (CVE) in adults in Madrid between 2015 and 2018, and to assess how social context and other individual characteristics modify the estimated association. We performed a case-crossover study using the individual information collected from electronic medical records of 6514 adults aged 40-75 living in Madrid city that suffered a first CVE during summer (June-September) between 2015 and 2018. We applied conditional logistic regression with a distributed lag non-linear model to analyse the heat-CVE association. Estimates were expressed as Odds Ratio (OR) for extreme heat (at 97.5th percentile of daily maximum temperature distribution), compared to the minimum risk temperature. We performed stratified analyses by specific diagnosis, sex, age (40-64, 65-75), country of origin, area-level deprivation, and presence of comorbidities. Overall, the risk of suffering CVE increased by 15.3% (OR: 1.153 [95%CI 1.010-1.317]) during extreme heat. Males were particularly more affected (1.248, [1.059-1.471]), vs 1.039 [0.810-1.331] in females), and non-Spanish population (1.869 [1.28-2.728]), vs 1.084 [0.940-1.250] in Spanish). Similar estimates were found by age groups. We observed a dose-response pattern across deprivation levels, with larger risks in populations with higher deprivation (1.228 [1.031-1.462]) and almost null association in the lowest deprivation group (1.062 [0.836-1.349]). No clear patterns of larger vulnerability were found by presence of comorbidity. We found that heat unequally increased the risk of suffering CVE in adults in Madrid, affecting mainly males and deprived populations. Local measures should pay special attention to vulnerable populations.
Physical activity is an integral part of every mammals daily life, and as a driver of Darwinian fitness, required coordinated evolution of the body and brain. The human population is currently in its most historically sedentary state, creating a global health crisis - necessitating improved understanding of exercise motivation. The decision to engage in physical activity can be driven by survival needs (e.g., escaping danger) or by the motivation for the rewarding nature of physical activity itself (e.g., running exercise). Rodents exhibit innate and learned motivation for voluntary wheel running exercise, and over time run for longer durations and distances, reflecting increased incentive salience and motivation for this consummatory behavior. Daily motivation for running is highly variable, which necessitates dynamic coordination of neural and somatic physiology (e.g., action planning and associated metabolic demand) to ensure the ability to carry out the planned activity. Hippocampal sharp wave-ripples (SWRs) evolved both cognitive (e.g., action planning) and metabolic (e.g., blood glucose regulation) functions, suggesting a role in such body-brain coordination. Here we monitored hippocampal CA1 local field potential activity and running levels in adult mice, while manipulating the incentive salience of running. During non-REM (NREM) sleep, the duration of SWRs before (but not after) running positively correlated with future time spent running, while in contrast, the rate of SWR occurrence both before and after exhibited a positive correlation. Because SWR durations reflect information content and rates reflect both information and metabolic signaling, our results suggest multiplexing of SWR dynamics as a mechanism supporting both cognitive and metabolic aspects of exercise. We hypothesize that SWRs coordinate body-brain interactions to a greater extent than previously known.
Introduction: Aging is an inevitable, complex and multifactorial process that leads to a set of physiological, biochemical and biomechanical changes. The present study aims to evaluate the relationship between peripheral oxygen saturation values, functional mobility, physical activity levels and quality of life in elderly people. Materials and methods: Cross-sectional study, with a sample (n = 48) of elderly people. Characterisation data, oxygen saturation values, functional mobility, physical activity levels, and quality of life were collected. Results: There were statistically significant differences (p ≤ 0.05) between the SpO2 values of subjects aged 65–79 years (96.3 ± 1.8%) versus those aged ≥ 80 years (94.6 ± 2.7%); and between those who reported mobility problems (94.6 ± 2.6) and those who did not (96.5 ± 1.6). We also observed a moderate positive correlation (r = 0.437) between SpO2 values and the mean number of steps recorded during 4 days and a moderate negative correlation (r = −487) with the times recorded in TUG. No statistically significant correlations were found between QoL and SpO2 levels. Conclusions: A decrease in SpO2 values was observed with age progression, and subjects with lower values had worse functional mobility and lowered physical activity levels. QoL is influenced by a wide range of internal and external conditions may explain the lack of significant correlations with SpO2. Even so, of the four QoL domains analysed, the physical domain showed the highest correlation coefficient.
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Sexuality is always a difficult and challenging issue for nurses to address with older patients. This is particularly the case in relation to responding to incidents of hypersexuality or inappropriate sexual expression as a result of dementia. Although research suggests that hypersexuality is a rare occurrence, when it happens it has the potential to jeopardize the quality of life of all concerned. The focus of this article is on exploring the literature on hypersexuality in people with dementia in the residential care setting. Information and principles of care are offered that may help nurses respond in a sensitive manner that protects the rights, dignity and autonomy of all concerned.
This paper reports the results of a literature review examining the effects of exercise on mental health and well-being. Throughout history many societies, ancient and modern, have used exercise as a means of preventing disease, and promoting health and well-being. There is evidence that exercise is beneficial for mental health; it reduces anxiety, depression, and negative mood, and improves self-esteem and cognitive functioning. Exercise is also associated with improvements in the quality of life of those living with Schizophrenia. However, exercise is seldom recognized by mainstream mental health services as an effective intervention in the care and treatment of mental health problems. There is evidence to suggest that exercise may be a neglected intervention in mental health care.
This paper reports the results of a literature review examining the effects of exercise on mental health and well-being. Throughout history many societies, ancient and modern, have used exercise as a means of preventing disease, and promoting health and well-being. There is evidence that exercise is beneficial for mental health; it reduces anxiety, depression, and negative mood, and improves self-esteem and cognitive functioning. Exercise is also associated with improvements in the quality of life of those living with Schizophrenia. However, exercise is seldom recognized by mainstream mental health services as an effective intervention in the care and treatment of mental health problems. There is evidence to suggest that exercise may be a neglected intervention in mental health care.
Research concerning the treatment of sexually inappropriate behavior in individuals with dementia, and information concerning the treatment of those problems is not abundant. The reasons for this relative neglect are many, but the discomfort caregivers feel in discussing sexual difficulties and the cultural bias of ageism undoubtedly contribute. This manuscript reviews the literature concerning sexually inappropriate behavior in demented individuals. Behavioral and pharmacological treatment approaches are explored, and recommendations and guidelines offered by other researchers are described. Caregiver stress and other potentially serious results that can accrue from sexually indiscreet behavior is investigated, and cautions regarding provider inattention to this issue are voiced.
Upwards of 7% of cognitively impaired elderly are reported to exhibit sexually disinhibited behaviors. These behaviors may be the result of either a chronic history of sexual disinhibition, regression, or sequel to a stroke, surgical intervention, vascular insult, blow to the head, or cardiac event in which observed cognitive deterioration is the acute symptom. Elderly patients who are sexually disinhibited may exhibit a behavior that makes it difficult to manage them at home or in a nursing home. A review of the treatment of sexual disinhibition with neurohormones is presented; guidelines for assessing risk and risk management are proposed; and a five-year study with 39 geriatric out patients with cognitive impairment and sexual disinhibitions reviewed. Case examples of sexual aggressives are followed by treatment recommendations in which an algorithm is presented. The treatment algorithm recommends beginning selective serotonin reuptake inhibitors medication before considering estrogen (preferably a patch) or antiandrogen therapy. The estrogen patch led to excellent treatment results in elderly demented men with sexual disinhibition. Elderly demented patients who are sexually disinhibited may be managed successfully with neurohormones if SSRI medication proves unsuccessful.
To discuss the pharmacologic options for treatment of hypersexuality or paraphilias in nursing home residents. A MEDLINE search was conducted for English-language articles published over the past 20 years and was supplemented by a search of bibliographies of relevant articles. Case reports of pharmacologic treatment of hypersexual or paraphilic behavior were selected only if the patient receiving treatment was an older person and/or cognitively impaired. Case reports were grouped according to the class of the pharmacologic agent used (antiandrogens, estrogens, GnRH analogues, or serotonergic drugs). Each case report was evaluated for pharmacologic agent administered, route of administration, duration of therapy, therapeutic response, and incidence of side effects. Nursing home residents who display hypersexual or paraphilic behavior are extremely difficult to manage. Before initiating pharmacotherapy to control unwanted sexual behaviors, the current drug regimen should be evaluated carefully for drugs that may be causing or exacerbating the behavior. Case reports suggest that antiandrogens, estrogens, GnRH analogues, and serotonergic medications may be useful when other methods have failed. Controlled comparative trials of these agents are needed to establish their efficacy clearly.
The article focuses on adverse drug reactions (ADR) to selective serotonin reuptake inhibitors (SSRI) concerning libido and sexual behaviour: cases of disinhibition of libido observed at the Psychiatric Hospital of Kilchberg near Zurich are described. Within the scope of a drug safety program, the physicians of the hospital are regularly asked about severe and unexpected events under drug treatment. During remission of depression, five outpatients noticed an increase of libido experienced as strange to them, i.e. preoccupation with sexual thoughts, first appearance of promiscuity, of unsafe sexual intercourse, and of excessive pursuit of pornography, respectively, during administration, change in dose or discontinuation of SSRI. The case studies suggest that SSRI treatment might be associated with increase and disinhibition of libido. The phenomena are discussed as a "selective switch" into partly manic symptomatology or an induction of mixed states with prevailing sexual symptoms.
This article reviews the studies on the effects of physical activity on the emotional states--anxiety, depression and mood. The meta-analyses of correlational and experimental studies reveal positive effects of exercise, in healthy people and in clinical populations (also in patients with emotional disorders) regardless of gender and age. The benefits are significant especially in subjects with an elevated level of anxiety and depression because of more room for possible change. The most improvements are caused by rhythmic, aerobic exercises, using of large muscle groups (jogging, swimming, cycling, walking), of moderate and low intensity. They should be conducted for 15 to 30 minutes and performed a minimum of three times a week in programs of 10-weeks or longer. The results confirm the acute effect of exercise i.e. the reductions in anxiety and depression after single sessions of exercise. The changes in anxiety, depression and mood states after exercise are explained most frequently by the endorphin and monoamine hypotheses. Exercise may also increase body temperature, blood circulation in the brain and impact on hypothalamic-pituitary-adrenal axis and physiological reactivity to stress. The possible psychological mechanisms include improvement of self-efficacy, distraction and cognitive dissonance.
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.