Exercise and Schizophrenia

Effectiveness of Walking Exercise in Improving Physical Fitness and Depression in Patients With Schizophrenia

Patients with schizophrenia often lack physical activity, which, together with physical complications, can lower their expected lifespan. Exercise strengthens their physical and mental health. The primary aim of this study was to examine the effectiveness of a walking exercise intervention in improving physical fitness, body mass index, waist-to-hip ratio, and depressive symptoms in patients with schizophrenia. A quasi-experimental study design was used. Seventy-six participants were recruited from the psychiatric daycare center at a hospital in Northern Taiwan. They were divided into two groups. The intervention group received a walking exercise intervention, while the control completed their daily courses at the psychiatric daycare center. The changes in both groups' physical fitness, BMI, waist-to-hip ratio, and depressive symptoms were monitored. Cardiorespiratory endurance significantly improved in the intervention group, attesting to the effectiveness of the walking exercise intervention. Their depression level significantly decreased across all measurement stages. The group walking exercise reduced sedentary behaviors and increased the participants' autonomous motivation, hip circumference, and cardiorespiratory fitness. Structured exercise programs may increase the patients' hippocampal neuroplasticity and reduce their depressive symptoms. The walking exercise intervention positively affected physiological traits, physical fitness, and mental health of the participants.

Effect of aerobic exercise versus cognitive remediation versus a combination of both on cognition among patients with schizophrenia: A three-arm, randomized controlled study

Aerobic exercise (AE) and cognitive remediation (CR) have both shown promising effects on cognition in schizophrenia. However, the efficacy of combining these interventions has not been thoroughly evaluated. We conducted a randomized controlled trial to test the 3-month effects of AE, CR, and their combination on cognition and functioning in patients with schizophrenia. A total of 59 patients were randomized into three groups: AE alone (n = 19), CR alone (n = 19), or a combination of both (n = 21). The intervention consisted of a combination of individual and group AEs and a computer-assisted CR. The overall retention rate was 91.53 %. The primary outcome was the change in cognition from baseline, assessed using the Brief Assessment of Cognition in Schizophrenia (BACS). Significant improvements from baseline to post-treatment were observed in the combined AE and CR group compared to the AE alone group for verbal memory, executive function, and the composite score on the BACS. Similarly, greater improvements were found in the combined AE and CR group than in the CR group alone in verbal memory, working memory, attention, executive function, and the composite BACS score, with effect sizes ranging from moderate to large. No significant differences were found in functional level changes from baseline to post-treatment in the pairwise comparisons between groups, as assessed using the modified Global Assessment of Functioning for social functioning Scale. Our results indicate that patients with schizophrenia in the combined AE and CR group achieved greater cognitive improvement than those in the AE or CR alone group.

Exploring the causal effects of physical activity, diet, and nutrition on hypertension and hyperlipidemia: a multivariable Mendelian randomization analysis

BACKGROUND AND AIM

Hypertension and hyperlipidaemia are major risk factors for cardiovascular diseases, contributing to significant morbidity and mortality worldwide. Lifestyle interventions, including modifications in diet, nutrition, and physical activity, are commonly recommended, but their causal effects on these conditions remain uncertain. This study aims to explore the causal effects of these factors on hypertension and hyperlipidaemia using multivariate Mendelian randomisation analysis, providing insights for effective cardiovascular prevention strategies.

METHODS AND RESULTS

Genetic data related to physical activity, diet, and nutrition were obtained from public databases and analyzed using multivariate Mendelian randomisation. The analysis employed MR Egger, weighted median, and inverse variance weighting (IVW) methods, with tests for heterogeneity and multiplicity ensuring the reliability of the results. In the hypertension analysis, low-calorie diets showed a positive association in weighted median and IVW analyses, with weighted median analysis showing an association of 1.122 (95% CI: 1.014-1.243, P = 0.026) and IVW analysis showing an association of 1.095 (95% CI: 1.013-1.184, P = 0.023). However, MR Egger's analysis showed no significant association (association of 0.688, 95% CI: 0.411-1.155, P = 0.230). Calcium supplements and dietary fibre did not demonstrate significant associations across all methods. Physical activity also did not show significant causal links with hypertension. Regarding hyperlipidaemia, calcium supplements exhibited significant effects across all methods, though with notable variation, while dietary fibre and physical activity showed no significant impacts.

CONCLUSIONS

The study suggests a positive association between low-calorie diets and hypertension, as indicated by significant results from weighted median and IVW analyses. Other dietary factors, physical activity, and calcium supplementation exhibited varied or non-significant effects on hypertension and hyperlipidaemia. These findings highlight the need for further research to understand the underlying mechanisms and support the development of effective public health interventions.

Demographic, biochemical, clinical, and cognitive symptom differences between smokers and non-smokers in Chinese older male patients with chronic schizophrenia

BACKGROUND

Several studies have suggested that smoking may impair cognitive function and worsen psychiatric symptoms in people with schizophrenia, but the results have not been consistent. There have been few studies to date that have examined the effects of smoking in older men with chronic schizophrenia.

METHODS

The participants in our study consisted of 167 order Chinese males with chronic schizophrenia and 359 normal control subjects. We split them into smoking and non-smoking groups based on whether or not they smoked. Second, we compared their differences in terms of general demographic characteristics (such as age, education, body mass index, age of illness onset, and course of disease), disease information (such as hypertension, diabetes, and hyperlipidemia), lifestyle factors (such as physical exercise and lunch break), blood biochemical indicators (such as albumin, triglyceride, total cholesterol, high-density lipoprotein, low-density lipoprotein and fasting blood glucose), and medication usage (such as clozapine, olanzapine, risperidone, and chlorpromazine). Lastly, a neuropsychological test battery was used to assess their psychiatric and cognitive symptoms, for example, the Montreal Cognitive Assessment (MoCA) was used to assess their overall cognitive functioning. Their depressive symptoms were assessed by the geriatric depression scale (GDS). Activities of daily living (ADL) were used to assess their ability to lead a daily life, while the positive and negative syndrome scales (PANSS) were used to assess their psychiatric symptoms.

RESULTS

Smokers who develop schizophrenia at older ages had a higher body mass index than non-smokers. We also found that plasma albumin, triglycerides, low-density lipoprotein, and fasting blood glucose concentrations were significantly higher in smokers. In contrast, smokers with schizophrenia also had lower PANSS total scores, negative symptom scores, and general psychopathology scores. A forward stepwise binary logistics regression analysis demonstrated a significant association between negative symptom scores and smoking status (B = 0.112, p < 0.001, OR = 1.119, 95% confidence interval: 1.059-1.181). Correlation analysis was carried out and it was found that the amount of cigarette consumption per day had a negative correlation with plasma albumin level(r = - 0.290, p = 0.004). However, no such association was found in normal controls.

CONCLUSIONS

Elderly Chinese men with schizophrenia have a higher percentage of smokers, and although smoking can reduce their plasma albumin levels, it does contribute to the prevention of negative symptoms.

The effect of exercise on depression and gut microbiota: Possible mechanisms

Exercise can effectively prevent and treat depression and anxiety, with gut microbiota playing a crucial role in this process. Studies have shown that exercise can influence the diversity and composition of gut microbiota, which in turn affects depression through immune, endocrine, and neural pathways in the gut-brain axis. The effectiveness of exercise varies based on its type, intensity, and duration, largely due to the different changes in gut microbiota. This article summarizes the possible mechanisms by which exercise affects gut microbiota and how gut microbiota influences depression. Additionally, we reviewed literature on the effects of exercise on depression at different intensities, types, and durations to provide a reference for future exercise-based therapies for depression.

Effect of antipsychotic on mismatch negativity amplitude and evoked theta power in drug-naïve patients with schizophrenia

BACKGROUND

Recurrent observations have indicated the presence of deficits in mismatch negativity (MMN) among schizophrenia. There is evidence suggesting a correlation between increased dopaminergic activity and reduced MMN amplitude, but there is no consensus on whether antipsychotic medications can improve MMN deficit in schizophrenia.

METHODS

We conducted clinical assessments, cognitive function tests, and EEG data collection and analysis on 31 drug-naïve patients with schizophrenia. Comprehensive evaluation tools such as PANSS and MCCB. MMN amplitude was analyzed by event-related potential (ERP) approaches, evoked theta power was analyzed by event-related spectral perturbation (ERSP) approaches.

RESULTS

Our findings indicate that antipsychotic treatment significantly improved clinical symptoms, as evidenced by reductions in PANSS positive, negative, general symptoms, and total scores (all p < 0.001). Cognitive function improvements were observed in language learning, working memory, and overall MCCB scores (p < 0.05), although other cognitive domains showed no significant changes. However, no significant improvements were noted in MMN amplitude and evoke theta power after four weeks of antipsychotic treatment (p > 0.05).

CONCLUSION

These results suggest that while antipsychotic medications effectively alleviate clinical symptoms, their impact on MMN amplitude and evoke theta power deficit is limited in the short term. Moreover, the amelioration of cognitive impairment in individuals with schizophrenia is not readily discernible, and it cannot be discounted that the enhancement observed in language acquisition and working memory may be attributed to a learning effect. These findings underscore the complexity of the neurobiological mechanisms involved and highlight the need for further research to optimize individualized treatment strategies for schizophrenia.

TRIAL REGISTRATION

ChiCTR2000038961, October 10, 2020.

Optimal exercise dose and type for improving schizophrenia symptoms in adults: A systematic review and Bayesian network meta-analysis

BACKGROUND

Exercise has shown promise in aiding patients with schizophrenia, potentially improving symptoms, quality of life, mood, and cognition. This review evaluates the effectiveness of different physical activities in this context, aiming to guide treatment and research towards the most beneficial exercise interventions for schizophrenia management.

METHODS

This systematic review and network meta-analysis searched PubMed, MEDLINE, Embase, PsycINFO, Cochrane CENTRAL, Web of Science, and CNKI up to March 30, 2024. We utilized the "gemtc," "MBNMAdose," "metafor," and "ggplot2" packages for data analysis in R. Additionally, our results were reported as standardized mean differences with 95 % confidence intervals. To assess the risk of bias in the included studies, we used ROB2 and CINeMA tools.

RESULTS

In the results section of our systematic review and network meta-analysis, we analyzed data from 47 studies involving 4031 participants. Our findings indicate that among the various exercise interventions examined for schizophrenia patients, yoga emerged as the most effective in improving Total symptoms, positive and negative symptoms. RT+AE (Resistance Training + Aerobic Exercise) showed the greatest improvement in general symptoms, whereas Tai Chi (TC) was the least effective. In terms of improvement of cognitive functions and depression, AE proved the most beneficial, while TC was found to be the least effective. EX+PT (Physical Exercise + Psychological Nursing) was identified as the most effective approach for improved quality of life, with TC again showing the least efficacy. The optimal total exercise dose to improve the patient's total symptoms was estimated to be 1200 METs-min/week. (SMD: -0.956, 95 %Crl: -1.376 to -0.536).

CONCLUSIONS

Yoga, RT+AE, EX+PT, and Baduanjin have demonstrated enhanced efficacy in alleviating clinical symptoms, quality of life, depressive states, and cognitive functions in patients with schizophrenia. We identified optimal overall exercise doses and provided exercise guidance recommendations for healthcare professionals.

Physical Activity in young female outpatients with BORderline personality Disorder (PABORD): a study protocol for a randomized controlled trial (RCT)

BACKGROUND

Current treatments for mental disorders, like pharmacotherapy or psychological approaches, do not lead to full remission in all individuals. Physical activity (PA) is effective at improving psycho-physical health in major depressive and anxiety disorders. However, the efficacy of PA as an adjunctive treatment for borderline personality disorder (BPD) has not been studied. To date, there are no approved pharmacological treatments for this severe condition and limited accessibility to effective psychotherapeutic interventions. This study tests the efficacy of a structured PA programme as an additional treatment for BPD outpatients.

METHODS

The PABORD is a randomised controlled trial for female outpatients (18-40 years) with a BPD diagnosis. The intervention group (n = 32) will participate in a 12-week structured PA programme supervised by a sport medicine physician and preceded by three psychoeducation sessions on healthy eating habits. The control group (n = 32) will receive a 12-week psychoeducation programme on PA, diet, and health risks of a sedentary lifestyle for a total of 8 sessions. The study aims to determine if the PA intervention is superior to the control in reducing BPD symptoms. Secondary aims include improving PA levels and physical and psychological health. Assessments will be conducted at baseline, post-intervention, and 3 months post-intervention.

DISCUSSION

The structured PA programme is expected to outperform the control group in terms of health and PA outcomes at the end of the intervention. Repeated assessments will also help to identify psychosocial factors that influence PA maintenance. Findings will support the potential widespread implementation of PA programmes for BPD treatment.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06461104. Registered on 6 June 2024 {2a}.

Comparative efficacy of different types of exercise modalities on psychiatric symptomatology in patients with schizophrenia: a systematic review with network meta-analysis

This network meta-analysis investigated the effects of 8 types of physical exercises on treating positive symptoms, negative symptoms, general psychopathology, and the Positive And Negative Syndrome Scale (PANSS) total score in patients with schizophrenia. The methods adhered to PRISMA guidelines and used the Cochrane risk of bias tool for quality assessment, and Stata software for data analysis. Data were sourced from PubMed, Embase, Web of Science, and the Cochrane database up to August 15, 2023, following PICOS principles. A total of 25 studies including 1441 participants were analyzed. Results showed that resistance exercise seems to be effective for improving positive symptoms, while Yoga was more effective for negative symptoms. Low-intensity aerobic exercise was optimal for general psychopathology, and Yoga was effective in improving the PANSS total score. The study concluded that yoga and aerobic exercise demonstrated superior performance, but the impact of exercise on patients with schizophrenia is also influenced by individual factors and intervention dosages. Therefore, a pre-assessment of patients considering factors such as interests, hobbies, and physical capabilities is crucial for selecting appropriate exercise modalities.

Efficacy and feasibility of aerobic exercise interventions as an adjunctive treatment for patients with schizophrenia: a meta-Analysis

Schizophrenia is a chronic mental disorder primarily treated with antipsychotics, which have limited efficacy for negative symptoms. This study aims to evaluate the effectiveness and feasibility of exercise interventions as adjuncts to pharmacotherapy through a meta-analysis, providing valuable insights for rational intervention design. Four databases were searched, and randomized controlled trials with no language restrictions published up to March 27, 2023, were included. The primary outcome indicator was the Positive and Negative Symptom Scale (PANSS) total score along with its three sub-scales. Secondary outcomes included the Scale for Assessment of Negative Symptoms (SANS) and Body Mass Index (BMI), which were used to assess the efficacy of aerobic exercise interventions in patients with schizophrenia. Subgroup analyses were conducted to explore the impact of intervention duration and total weekly exercise time, while treatment feasibility was assessed through adherence rates. A total of 17 publications involving 973 patients with schizophrenia were deemed eligible and included in the analysis. Compared to other forms of adjunctive interventions, the network meta-analysis of 12 PANSS-based studies revealed that adjunctive aerobic exercise interventions were the most effective in reducing overall PANSS scores in patients with schizophrenia, with statistically significant pooled results (MD = -4.84, 95% CI: -5.72, -3.96). Both the PANSS negative symptom subscale (MD = -2.11, 95% CI: -3.26, -0.95) and SANS (MD = -9.11, 95% CI: -11.94, -6.27) indicated that adjunctive aerobic exercise interventions effectively alleviate negative symptoms. Subgroup meta-analysis indicated that 2-3 month interventions involving 100-220 min of exercise per week were the most effective. Additionally, adherence to the adjunctive aerobic exercise regimen was found to be comparable to that of conventional treatment alone. Aerobic exercise interventions, as adjunctive therapy, are an effective measure for reducing PANSS scores in patients with schizophrenia, contributing to the alleviation of both the positive and negative symptoms, and patients demonstrated strong adherence to aerobic exercise.

Biopsychosocial Variables in Male Schizophrenic Patients: A Comprehensive Comparison with Healthy Controls

OBJECTIVE

this study aims to comprehensively compare neuropsychological, psychopathological, anthropometric, biochemical, pharmacological, and lifestyle variables between 27 male schizophrenic patients (SZ group) and 30 age- and sex-matched healthy male controls (HC group).

METHODS

participants underwent a battery of neuropsychological tests including the Trail Making Test (TMT), Stroop Color-Word Interference Test, and Verbal Fluency Test. Psychopathological symptoms in the SZ group were evaluated using the Positive and Negative Syndrome Scale (PANSS). Anthropometric measurements such as body weight, height, BMI, and waist circumference were taken. Biochemical markers measured included fasting glucose, total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and fasting insulin. Lifestyle factors were assessed through a questionnaire for the study of views and eating habits of people aged 16 to 65.

RESULTS

the HC group outperformed the SZ group in the TMT_A test and the Stroop test, but no significant differences were observed in the TMT_B test or in phonemic fluency tests. No correlation was found between age and PANSS scores within the SZ group. Anthropometrically, the SZ group had higher body weight, waist circumference, and BMI, with no difference in height. Biochemically, the HC group had higher HDL cholesterol levels but lower insulin and insulin resistance indices. Pharmacological assessment showed a more significant impact on body weight among SZ patients taking second-generation antipsychotics. Lifestyle factors such as diet and screen time were comparable between groups, but the SZ group reported longer sleep duration and lower leisure time activity.

CONCLUSIONS

our study highlights distinct neuropsychological, pharmacological, anthropometric, and biochemical differences between male schizophrenic patients and healthy controls. The results underscore the complexity of schizophrenia and point toward the need for a multi-faceted approach to its management and understanding.

"Out-of-Hospital and with Qualified Exercise Professionals": Keys to the CORTEX-SP Physical Exercise Program According to the Experience of the Participants

Physical exercise programs are useful and necessary for the treatment of schizophrenia. The aim of this study was to assess the experiences of participants with schizophrenia in an out-of-hospital exercise program designed and supervised by qualified exercise professionals. Thirty-five individuals with schizophrenia from the intervention group of the CORTEX-SP study were interviewed. The interviews were transcribed verbatim and content analysis was performed using inductive coding. Two main categories emerged: the importance of the program being conducted out-of-hospital, and the individuals responsible for the program being qualified exercise professionals. The participants highlighted the importance of conducting the program outside the psychiatric center since it gave them greater satisfaction. They perceived greater seriousness and a greater number of resources and felt encouraged to repeat the program or prolong it. The success of the program, in addition to the space, was due to the personnel in charge of the program, i.e., the qualified exercise professionals, and the fact that the activities were designed and supervised. Participants emphasized the qualifications of the exercise professionals, key for this type of program, their social skills and the level of involvement with participants and their follow-up.

Value of gym-based group exercise versus usual care for young adults receiving antipsychotic medication: study protocol for the multicenter randomized controlled Vega trial

BACKGROUND

Exercise is recommended to protect physical health among people with severe mental illness and holds the potential to facilitate long-term recovery. An inclusive exercise community provides an opportunity for life skill training and social connectedness and may reduce the experience of loneliness and internalized stigmatization which together may improve personal recovery. Using a pragmatic randomized design, we aim to examine the effectiveness of a gym-based exercise intervention tailored to young adults in antipsychotic treatment (i.e., Vega Exercise Community) compared to usual care. It is hypothesized that the Vega Exercise Community will be superior to usual care for personal recovery at four months.

METHODS

The trial will be conducted at four sites in Denmark from which 400 participants, aged 18 to 35 years, who are in current treatment with antipsychotic medications for the management of schizophrenia spectrum or affective disorders, will be recruited. Participants will be randomized (2:1) to Vega Exercise Community or usual care. Vega Exercise Community includes three weekly group-based exercise sessions hosted in commercial functional training centers delivered by certified Vega instructors. After four months, participants in Vega Exercise Community will be randomized (1:1) to minimal versus extended support with regards to sustained physical activity. Data will be collected at baseline, four, six and 12 months. The primary outcome is personal recovery assessed by Questionnaire about the Process of Recovery at four months. Behavioral symptoms, health-related quality of life, metabolic health, and program costs will be evaluated to further determine the effectiveness and cost-effectiveness of the Vega Exercise Community. Finally, the quality of life and physical and mental health of the participants' primary relative will be evaluated.

DISCUSSION

The results of this trial may have important implications for health, sustained physical activity, and recovery for individuals in treatment with antipsychotics. Given the pragmatic design, positive results may readily be implemented by mental health care professionals to promote exercise as an integrated part of treatment of severe mental illness.

TRIAL REGISTRATION

Clinical Trials.gov (NCT05461885, initial registration June 29th, 2022). WHO Universal Trial Number (UTN): U1111-1271-9928.

'It Helped Me to Disconnect My Mind from the Problems': The Subjective Experiences of People with Schizophrenia Taking Part in a Concurrent Exercise Program

The aim of this study was to investigate the subjective experiences of a concurrent exercise program designed to improve both physical and mental health, through participation, for people with schizophrenia. Participants diagnosed with schizophrenia (n = 35, 41.6 ± 10.3 years) received an intensive concurrent exercise program for a 5-month duration, three times a week, at out-of-hospital facilities. Qualitative data was collected via individual, semi-structured interviews, organized, and analyzed with thematic analysis. The findings highlight the participants' perspective in supporting an out-of-hospital exercise program as an acceptable and beneficial adjunct to usual treatment in people with schizophrenia for holistic health improvements.

Sarcosine (glycine transporter inhibitor) attenuates behavioural and biochemical changes induced by ketamine, in the rat model of schizophrenia

Schizophrenia is a neurological disorder that alters the behavior and affects the quality of life of a patient. It is characterized by hallucinations, disorganized behavior, cognitive dysfunction, hyperlocomotion, and loss of the reward system. Schizophrenia constitutes three symptoms' domains, viz. positive, negative and cognitive. Typical and atypical antipsychotics do not fully resolve all the symptoms' domains thus paving the way to the genesis of the glutamatergic hypothesis, i.e. N-methyl-D-aspartate (NMDA) receptor hypofunction in the pathophysiology of schizophrenia. Positive modulation of NMDA receptors by enhancing co-agonist, glycine effect is proposed to produce a therapeutic effect in schizophrenia. Hence, sarcosine (N-methyl glycine), natural amino acid, and a glycine transporter inhibitor (GlyT-1) which also acts on NMDA receptors were used in the present study. The present study unravels the role of sarcosine in the attenuation of ketamine-induced three symptom domains in a rat model through modulation of oxidative stress, mitochondrial dysfunction, and neuroinflammatory pathways. The animal model of schizophrenia was established by injecting ketamine intraperitoneal (ip) at a 30 mg/kg dose for 10 consecutive days, after which sarcosine (300, 600 mg/kg, ip) as a treatment was given for 7 days followed by behavioral, biochemical, molecular, and histopathological analysis. It was revealed that sarcosine reversed ketamine-induced behavioral impairments. Moreover, sarcosine ameliorated oxidative and nitrosative stress, mitochondrial dysfunction, and neuroinflammation and showed protective effects in histopathological examination by hematoxylin and eosin staining. Hence, conclusively, sarcosine was regarded to attenuate the behavioural symptoms of schizophrenia by alleviating oxidative stress, neuroinflammation, and mitochondrial dysfunction established by the ketamine.

Patterns of multimorbidity and some psychiatric disorders: A systematic review of the literature

Objective

The presence of two or more chronic diseases results in worse clinical outcomes than expected by a simple combination of diseases. This synergistic effect is expected to be higher when combined with some conditions, depending on the number and severity of diseases. Multimorbidity is a relatively new term, with the first fundamental definitions appearing in 2015. Studies usually define it as the presence of at least two chronic medical illnesses. However, little is known regarding the relationship between mental disorders and other non-psychiatric chronic diseases. This review aims at investigating the association between some mental disorders and non-psychiatric diseases, and their pattern of association.

Methods

We performed a systematic approach to selecting papers that studied relationships between chronic conditions that included one mental disorder from 2015 to 2021. These were processed using Covidence, including quality assessment.

Results

This resulted in the inclusion of 26 papers in this study. It was found that there are strong associations between depression, psychosis, and multimorbidity, but recent studies that evaluated patterns of association of diseases (usually using clustering methods) had heterogeneous results. Quality assessment of the papers generally revealed low quality among the included studies.

Conclusions

There is evidence of an association between depressive disorders, anxiety disorders, and psychosis with multimorbidity. Studies that tried to examine the patterns of association between diseases did not find stable results.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021216101, identifier: CRD42021216101.

Physical comorbidity and use of healthcare services in people with schizophrenia: protocol for a systematic review

INTRODUCTION

People with schizophrenia die about 15-20 years earlier than the general population. A constellation of factors contributes to this gap in life expectancy: side effects of psychotropic drugs, unhealthy lifestyles (inactivity, unhealthy diet) and inequality in the provision of healthcare services. This is a topic of main importance, which requires constant update and synthesis of the literature. The aim of this review is to explore the evidence of physical comorbidity and use of healthcare services in people with schizophrenia.

METHODS AND ANALYSIS

We will conduct a systematic literature search in the databases PubMed/MEDLINE, EMBASE, Scopus, Web of Science, PsycINFO and Cochrane Library, Proquest Health Research Premium Collection, in order to identify studies that answer to our research question: Are patients with schizophrenia different from the non-psychiatric population in terms of physical comorbidity and use of healthcare services? Two authors will independently review the studies and extract the data.

ETHICS AND DISSEMINATION

This study does not include human or animal subjects. Thus, ethics considerations are not applicable. Dissemination plans include publications in peer-reviewed journals and discussion of results in psychiatric congresses.

PROSPERO REGISTRATION NUMBER

CRD42020139972.

Relationship between stressful life events, coping styles, and schizophrenia relapse

This study aimed to explore the relationship between stressful life events, coping styles, and schizophrenia relapse. The sample for this study included 248 patients with schizophrenia from a psychiatric outpatient clinic in Hunan Province, China. Stressful life events, occurrence of schizophrenia relapse, and coping style were assessed by the Scale for the Social Readjustment Rating, Brief Psychiatric Rating Scale, and Simplified Coping Style Questionnaire, respectively. Spearman correlation analysis and binary logistic regression analysis were adopted to explore the relationships among coping styles, schizophrenia relapse, and stressful life events. Stressful life events and negative coping exhibited significant positive association with schizophrenia relapse, while positive coping exhibited a significant negative association with schizophrenia relapse. Stressful life events and positive coping exerted significant effects on schizophrenia relapse, while negative coping did not. We also found that both positive coping and negative coping have moderating effects on the relationship between stressful life events and schizophrenia relapse, but the relationship is weak. The study highlighted the importance of interventions designed to reduce stressful life events, promote positive coping, and address negative coping in patients with schizophrenia.

Exercise training complementary to specialised early intervention in patients with first-episode psychosis: a feasibility randomised trial

Background

The aim of this study was to examine feasibility of trial processes and group-based, structured exercise training in patients with first-episode psychosis.

Methods

Twenty-five patients with first-episode psychosis took part in a two-arm randomised feasibility trial. They were individually randomised (1:1) via a computer-generated randomisation sequence and allocated to either an exercise intervention group (INT) or a control group (CON). Patients allocated to INT completed a physical exercise training programme at moderate-to-vigorous intensity, 1 h three times weekly for 8 weeks. CON patients were encouraged to continue their usual level of activity and were offered the training programme after 8 weeks. Primary outcomes included screening rate, recruitment rate, retention rate, attendance and adverse events. Secondary outcomes included heart rate response during training, cardiovascular health (VO_2max, resting heart rate, blood pressure), body composition (muscle mass, fat percentage), muscle strength (sit-to-stand, grip strength, jump height) and balance.

Results

Recruitment lasted 6 weeks and 86 out of 324 patients (27%) were screened, 71 of whom (83%) were deemed eligible. Twenty-five (35%) accepted inclusion (mean age 25.5; mean body mass index 25.1) and were subsequently randomised (INT = 13, CON = 12). Retention of patients was 76% and 52% at the 8-week and 16-week follow-up, respectively. Attendance was 43% (min. 9%, max. 96%). No significant changes were observed between groups in secondary physiological outcome measures.

Conclusions

Feasibility was challenged by limited recruitment and retention rates, suggesting that modifications are required if a large-scale randomised controlled trial is to be conducted. Recommendations for modifications are presented and discussed.

Trial registration

Clinicaltrials.gov, NCT03409393. Retrospectively registered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-021-00900-5.

Preventive psychiatry: a blueprint for improving the mental health of young people

Preventive approaches have latterly gained traction for improving mental health in young people. In this paper, we first appraise the conceptual foundations of preventive psychiatry, encompassing the public health, Gordon's, US Institute of Medicine, World Health Organization, and good mental health frameworks, and neurodevelopmentally-sensitive clinical staging models. We then review the evidence supporting primary prevention of psychotic, bipolar and common mental disorders and promotion of good mental health as potential transformative strategies to reduce the incidence of these disorders in young people. Within indicated approaches, the clinical high-risk for psychosis paradigm has received the most empirical validation, while clinical high-risk states for bipolar and common mental disorders are increasingly becoming a focus of attention. Selective approaches have mostly targeted familial vulnerability and non-genetic risk exposures. Selective screening and psychological/psychoeducational interventions in vulnerable subgroups may improve anxiety/depressive symptoms, but their efficacy in reducing the incidence of psychotic/bipolar/common mental disorders is unproven. Selective physical exercise may reduce the incidence of anxiety disorders. Universal psychological/psychoeducational interventions may improve anxiety symptoms but not prevent depressive/anxiety disorders, while universal physical exercise may reduce the incidence of anxiety disorders. Universal public health approaches targeting school climate or social determinants (demographic, economic, neighbourhood, environmental, social/cultural) of mental disorders hold the greatest potential for reducing the risk profile of the population as a whole. The approach to promotion of good mental health is currently fragmented. We leverage the knowledge gained from the review to develop a blueprint for future research and practice of preventive psychiatry in young people: integrating universal and targeted frameworks; advancing multivariable, transdiagnostic, multi-endpoint epidemiological knowledge; synergically preventing common and infrequent mental disorders; preventing physical and mental health burden together; implementing stratified/personalized prognosis; establishing evidence-based preventive interventions; developing an ethical framework, improving prevention through education/training; consolidating the cost-effectiveness of preventive psychiatry; and decreasing inequalities. These goals can only be achieved through an urgent individual, societal, and global level response, which promotes a vigorous collaboration across scientific, health care, societal and governmental sectors for implementing preventive psychiatry, as much is at stake for young people with or at risk for emerging mental disorders.

An update in toxicology of ageing

The field of ageing research has been rapidly advancing in recent decades and it had provided insight into the complexity of ageing phenomenon. However, as the organism-environment interaction appears to significantly affect the organismal pace of ageing, the systematic approach for gerontogenic risk assessment of environmental factors has yet to be established. This puts demand on development of effective biomarker of ageing, as a relevant tool to quantify effects of gerontogenic exposures, contingent on multidisciplinary research approach. Here we review the current knowledge regarding the main endogenous gerontogenic pathways involved in acceleration of ageing through environmental exposures. These include inflammatory and oxidative stress-triggered processes, dysregulation of maintenance of cellular anabolism and catabolism and loss of protein homeostasis. The most effective biomarkers showing specificity and relevancy to ageing phenotypes are summarized, as well. The crucial part of this review was dedicated to the comprehensive overview of environmental gerontogens including various types of radiation, certain types of pesticides, heavy metals, drugs and addictive substances, unhealthy dietary patterns, and sedentary life as well as psychosocial stress. The reported effects in vitro and in vivo of both recognized and potential gerontogens are described with respect to the up-to-date knowledge in geroscience. Finally, hormetic and ageing decelerating effects of environmental factors are briefly discussed, as well.

The Effect of Yijinjing on the Cognitive Function of Patients With Chronic Schizophrenia

Background: Patients with chronic schizophrenia present cognitive impairment, which affects their social function and prevents them from reintegrating into society. Yijinjing is a traditional Chinese aerobic exercise that has a putative psychosomatic effect on improving cognitive function. Methods: From January to May 2021, 40 patients with chronic schizophrenia were recruited and randomly divided into a control group and a Yijinjing group. In the 12-week intervention, the patients in the control group received conventional treatment, whereas patients in the Yijinjing group performed Yijinjing exercise (40 min/session, twice a week) in addition to receiving conventional treatment. The Positive and Negative Syndrome Scale (PANSS), the Insight and Treatment Attitude Questionnaire (ITAQ), the Rosenberg Self-esteem Scale (SES), and the Mini Mental State Examination (MMSE) were used to measure clinical symptoms and cognitive function at 0, 6, and 12 weeks. Results: The demographic information was not significantly different between groups. At baseline, the scores of all the scales were not statistically different between groups. After 12 weeks of intervention, compared to those at baseline, the scores of the negative scale (t = 19.00, p < 0.0001), general psychopathology scale (t = 15.98, p < 0.0001), and total score (t = 15.47, p < 0.0001) of the PANSS and SES (t = 5.378, p < 0.0001) had significantly decreased, and the scores of the ITAQ (t = 7.984, p < 0.0001) and MMSE (t = 6.750, p < 0.0001) had significantly increased in Yijinjing group; the score of the MMSE increased in the control group as well (t = 2.491, p = 0.0222). Compared to the respective scores in the control group, the negative scale score (t = 2.953, p = 0.0054) significantly decreased, and the ITAQ (t = 3.043, p = 0.0042) and MMSE (t = 2.2.68, p = 0.0291) scores significantly increased in the Yijinjing group after 12 weeks of intervention. Conclusion: These results provide a preliminary indication that Yijinjing exercise had the potential to improve cognitive function and negative symptoms in patients with chronic schizophrenia. A larger-scale study to determine the trajectory of change in the longer term should be undertaken.