Physical activity and fitness in adolescents at risk for psychosis within the Northern Finland 1986 Birth Cohort

[Sports and Physical Exercise Therapy in the Treatment of Mental Health Issues in Children and Adolescents]

Sports and Physical Exercise Therapy in the Treatment of Mental Health Issues in Children and Adolescents Abstract: Mental disorders are among the most common chronic diseases in childhood and adolescence in Germany and worldwide. The health benefits of a physically active lifestyle during adolescence are well documented. Furthermore, a growing body of evidence suggests a positive impact of physical activity on mental health and emotional well-being. Longitudinal studies also show an association between physical activity and reduced risk of developing a mental disorder. Therefore, therapeutic exercise plays an important role in child and adolescent psychiatry. High-quality randomized-controlled trials are needed to substantiate the described effects.

Variability of glucose, insulin, and lipid disturbances in first-episode psychosis: a meta-analysis

BACKGROUND

First-episode psychosis (FEP) is associated with metabolic alterations. However, it is not known if there is heterogeneity in these alterations beyond what might be expected due to normal individual differences, indicative of subgroups of patients at greater vulnerability to metabolic dysregulation.

METHODS

We employed meta-analysis of variance, indexed using the coefficient of variation ratio (CVR), to compare variability of the following metabolic parameters in antipsychotic naïve FEP and controls: fasting glucose, glucose post-oral glucose tolerance test (OGTT), fasting insulin, insulin resistance, haemoglobin A1c (HbA1c), total-cholesterol, low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol, and triglycerides. Standardised mean difference in metabolic parameters between groups was also calculated; meta-regression analyses examined physiological/demographic/psychopathological moderators of metabolic change.

RESULTS

Twenty-eight studies were analysed (1716 patients, 1893 controls). Variability of fasting glucose [CVR = 1.32; 95% confidence interval (CI) 1.12-1.55; p = 0.001], glucose post-OGTT (CVR = 1.43; 95% CI 1.10-1.87; p = 0.008), fasting insulin (CVR = 1.31; 95% CI 1.09-1.58; p = 0.01), insulin resistance (CVR = 1.34; 95% CI 1.12-1.60; p = 0.001), HbA1c (CVR = 1.18; 95% CI 1.06-1.27; p < 0.0001), total-cholesterol (CVR = 1.15; 95% CI 1.01-1.31; p = 0.03), LDL-cholesterol (CVR = 1.28; 95% CI 1.09-1.50; p = 0.002), and HDL-cholesterol (CVR = 1.15; 95% CI 1.00-1.31; p < 0.05), but not triglycerides, was greater in patients than controls. Mean glucose, glucose post-OGTT, fasting insulin, insulin resistance, and triglycerides were greater in patients; mean total-cholesterol and HDL-cholesterol were reduced in patients. Increased symptom severity and female sex were associated with worse metabolic outcomes.

CONCLUSIONS

Patients with FEP present with greater variability in metabolic parameters relative to controls, consistent with a subgroup of patients with more severe metabolic changes compared to others. Understanding determinants of metabolic variability could help identify patients at-risk of developing metabolic syndrome. Female sex and severe psychopathology are associated with poorer metabolic outcomes, with implications for metabolic monitoring in clinical practice.

Exercise Intervention in Individuals at Clinical High Risk for Psychosis: Benefits to Fitness, Symptoms, Hippocampal Volumes, and Functional Connectivity

BACKGROUND AND HYPOTHESIS

Individuals at clinical high risk for psychosis (CHR-p) are less fit than nonclinical peers and show hippocampal abnormalities that relate to clinical symptoms. Exercise generates hippocampal neurogenesis that may ameliorate these hippocampal abnormalities and related cognitive/clinical symptoms. This study examines the impact of exercise on deficits in fitness, cognitive deficits, attenuated psychotic symptoms, hippocampal volumes, and hippocampal connectivity in individuals at CHR-p.

STUDY DESIGN

In a randomized controlled trial, 32 individuals at CHR-p participated in either an exercise (n = 17) or waitlist (no exercise) (n = 15) condition. All participants were sedentary at use and absent of current antipsychotic medication, psychosis diagnoses, or a substance use disorder. The participants completed a series of fitness, cognitive tasks, clinical assessments, and an MRI session preintervention and postintervention. The exercise intervention included a high-intensity interval exercise (80% of VO2max) with 1-minute high-intensity intervals (95% of VO2max) every 10 minutes) protocol twice a week over 3 months.

STUDY RESULTS

The exercise intervention was well tolerated (83.78% retention; 81.25% completion). The exercising CHR-p group showed that improved fitness (pre/post-d = 0.53), increased in cognitive performance (pre/post-d = 0.49), decrease in positive symptoms (pre/post-d = 1.12) compared with the waitlist group. Exercising individuals showed stable hippocampal volumes; waitlist CHR-p individuals showed 3.57% decreased hippocampal subfield volume. Exercising individuals showed that increased exercise-related hippocampal connectivity compared to the waitlist individuals.

CONCLUSIONS

The exercise intervention had excellent adherence, and there were clear signs of mechanism engagement. Taken together, evidence suggests that high-intensity exercise can be a beneficial therapeutic tool in the psychosis risk period.

Schizotypy, Lifestyle Behaviors, and Health Indicators in a Young Adult Sample

Problematic lifestyle behaviors and high rates of physical illness are well documented in people with schizophrenia, contributing to premature mortality. Yet, there is a notable absence of research examining general lifestyle and health issues in participants at risk for psychosis. This form of research may help identify concerns that exist during prodromal periods related to future outcomes. Accordingly, the current study examined lifestyle and health in a nonclinical sample of 530 young adults with varying levels of schizotypy. Increasing symptom severity was associated with greater somatic symptoms and poorer sleep quality across positive, negative, and disorganized domains. Elevated negative and disorganized symptoms were associated with significantly reduced health-related quality of life, while evidence for reduced engagement in health behaviors was largely limited to those with elevated negative schizotypy. No relationships emerged between symptom presentation/severity and body mass index or substance use, although zero-order correlations suggested an association between disorganized schizotypy and nicotine use. The pattern of relationships in the current study was consistent with findings from the ultra-high risk and clinical literature suggesting that lifestyle and health concerns may exist on a continuum with psychosis. Future research should seek to clarify if these patterns are associated with long-term physical or mental health outcomes.

Psychosis risk individuals show poor fitness and discrepancies with objective and subjective measures

Exercise is a promising intervention for individuals at clinical high-risk for psychosis (CHR). However, these youth may not be reliable reporters on fitness. There have been no investigations that utilized objective fitness assessment in this population. The present study objectively characterizes the level of fitness in CHR youth, compares the accuracy of self-report measures to objective fitness indices, and explores clinical factors that may influence the accuracy of self-reported measures of fitness. Forty CHR individuals completed an exercise survey and objective indices of fitness (i.e., VO2max and BMI). Forty healthy volunteers completed objective indices of fitness and a structured clinical interview ruling out the presence of psychiatric illness. CHR youth showed greater BMI and lowered VO2max compared to healthy volunteers. In the CHR group, self-report items (perceived fitness) did not reflect objective indices of fitness, whereas specific exercise behaviors (intensity of exercise) showed stronger correlations with objective fitness measurements. Exploratory analyses suggested that symptoms (grandiosity and avolition) related to errors in self-perception. Results indicate that CHR individuals are less fit than controls as indexed by objective measures of fitness and that it is important to consider unique population clinical characteristics when employing self-report data.

Associations Between Maternal Prenatal C-Reactive Protein and Risk Factors for Psychosis in Adolescent Offspring: Findings From the Northern Finland Birth Cohort 1986

Prenatal infection is associated with brain structural and functional abnormalities and may increase the risk for psychosis through a direct effect on neurodevelopment. Various infections may exert their effect through a proinflammatory immune response but studies of prenatal maternal inflammatory markers and offspring neurodevelopment are scarce. Using the longitudinal Northern Finland Birth Cohort 1986 study, we examined the associations of maternal prenatal C-reactive protein (CRP) levels with psychosis risk factors in adolescent offspring. CRP was measured in maternal sera collected in pregnancy. In offspring, school performance was measured at age 7 years, while school performance, psychotic experiences, and cannabis use were measured at age 16 years. We tested associations of CRP with offspring measures using regression analysis controlling for offspring sex, maternal education level, and prenatal maternal body mass index, smoking and alcohol use in pregnancy, place of birth, maternal psychiatric admission, paternal psychiatric admission, mothers age at birth, and gestational week of CRP sample. We also tested if adolescent cannabis use mediated the associations between maternal CRP and offspring outcomes. Controlling for covariates, maternal CRP was associated with academic performance at age 16 years (beta = .062, 95% CI = 0.036-0.088), but not with possible psychotic experiences at 16 years (odds ratio [OR] = 1.09, 95% CI = 0.96-1.24). Maternal CRP was also associated with adolescent cannabis use (OR = 1.24, 95% CI = 1.07-1.43). These findings suggest that prenatal inflammation may influence later mental illness risk by affecting neurodevelopment and also indirectly by increasing the risk of exposure to cannabis.

Sensorimotor and Activity Psychosis-Risk (SMAP-R) Scale: An Exploration of Scale Structure With Replication and Validation

BACKGROUND

Sensorimotor abnormalities precede and predict the onset of psychosis. Despite the practical utility of sensorimotor abnormalities for early identification, prediction, and individualized medicine applications, there is currently no dedicated self-report instrument designed to capture these important behaviors. The current study assessed and validated a questionnaire designed for use in individuals at clinical high-risk for psychosis (CHR).

METHODS

The current study included both exploratory (n = 3009) and validation (n = 439) analytic datasets-that included individuals identified as meeting criteria for a CHR syndrome (n = 84)-who completed the novel Sensorimotor Abnormalities and Psychosis-Risk (SMAP-R) Scale, clinical interviews and a finger-tapping task. The structure of the scale and reliability of items were consistent across 2 analytic datasets. The resulting scales were assessed for discriminant validity across CHR, community sample non-psychiatric volunteer, and clinical groups.

RESULTS

The scale showed a consistent structure across 2 analytic datasets subscale structure. The resultant subscale structure was consistent with conceptual models of sensorimotor pathology in psychosis (coordination and dyskinesia) in both the exploratory and the validation analytic dataset. Further, these subscales showed discriminant, predictive, and convergent validity. The sensorimotor abnormality scales discriminated CHR from community sample non-psychiatric controls and clinical samples. Finally, these subscales predicted to risk calculator scores and showed convergent validity with sensorimotor performance on a finger-tapping task.

CONCLUSION

The SMAP-R scale demonstrated good internal, discriminant, predictive, and convergent validity, and subscales mapped on to conceptually relevant sensorimotor circuits. Features of the scale may facilitate widespread incorporation of sensorimotor screening into psychosis-risk research and practice.

Considering the Microbiome in Stress-Related and Neurodevelopmental Trajectories to Schizophrenia

Early life adversity and prenatal stress are consistently associated with an increased risk for schizophrenia, although the exact pathogenic mechanisms linking the exposures with the disease remain elusive. Our previous view of the HPA stress axis as an elegant but simple negative feedback loop, orchestrating adaptation to stressors among the hypothalamus, pituitary, and adrenal glands, needs to be updated. Research in the last two decades shows that important bidirectional signaling between the HPA axis and intestinal mucosa modulates brain function and neurochemistry, including effects on glucocorticoid hormones and brain-derived neurotrophic factor (BDNF). The intestinal microbiome in earliest life, which is seeded by the vaginal microbiome during delivery, programs the development of the HPA axis in a critical developmental window, determining stress sensitivity and HPA function as well as immune system development. The crosstalk between the HPA and the Microbiome Gut Brain Axis (MGBA) is particularly high in the hippocampus, the most consistently disrupted neural region in persons with schizophrenia. Animal models suggest that the MGBA remains influential on behavior and physiology across developmental stages, including the perinatal window, early childhood, adolescence, and young adulthood. Understanding the role of the microbiome on critical risk related stressors may enhance or transform of understanding of the origins of schizophrenia and offer new approaches to increase resilience against stress effects for preventing and treating schizophrenia.

Difficulty in making contact with others and social withdrawal as early signs of psychosis in adolescents – the Northern Finland Birth Cohort 1986

Aim

Social withdrawal is among the first signs of the prodromal state of psychosis seen in clinical samples. The aim of this prospective study was to find out whether difficulty in making contact with others and social withdrawal precede first episode psychosis in the young general population.

Methods

The members of the Northern Finland Birth Cohort 1986 (n = 6274) completed the PROD-screen questionnaire in 2001–2002. The Finnish Hospital Discharge Register was used to detect both new psychotic and non-psychotic disorders requiring hospitalisation during 2003–2008.

Results

Twenty-three subjects developed psychosis and 89 developed a non-psychotic mental disorder requiring hospitalisation during the follow-up. Of those who developed psychosis, 35% had reported difficulty or uncertainty in making contact with others and 30% social withdrawal in adolescence. In hospitalised non-psychotic disorder, the corresponding precentages were 10 and 13% and in the control group without hospital-treated mental disorder 9 and 11%. The differences between psychotic and non-psychotic hospitalised subjects (P < 0.01) as well as controls (P < 0.001) were statistically significant regarding difficulty or uncertainty in making contact with others.

Conclusions

In this general population-based sample self-reported difficulty or uncertainty in making contact with others in adolescence preceded psychosis specifically compared to hospitalised non-psychotic mental disorders and controls.

School success in childhood and subsequent prodromal symptoms and psychoses in the Northern Finland Birth Cohort 1986

BACKGROUND

Low IQ is a risk factor for psychosis, but the effect of high IQ is more controversial. The aim was to explore the association of childhood school success with prodromal symptoms in adolescence and psychoses in adulthood.

METHODS

In the general population-based Northern Finland Birth Cohort 1986 (n = 8 229), we studied the relationship between teacher-assessed learning deficits, special talents and general school success at age 8 years and both prodromal symptoms (PROD-screen) at age 15-16 years and the occurrence of psychoses by age 30 years.

RESULTS

More prodromal symptoms were experienced by those talented in oral presentation [boys: adjusted odds ratio (OR) 1.49; 95% confidence interval 1.14-1.96; girls: 1.23; 1.00-1.52] or drawing (boys: 1.44; 1.10-1.87). Conversely, being talented in athletics decreased the probability of psychotic-like symptoms (boys: OR 0.72; 0.58-0.90). School success below average predicted less prodromal symptoms with boys (OR 0.68; 0.48-0.97), whereas above-average success predicted more prodromal symptoms with girls (OR 1.22; 1.03-1.44). The occurrence of psychoses was not affected. Learning deficits did not associate with prodromal symptoms or psychoses.

CONCLUSIONS

Learning deficits in childhood did not increase the risk of prodromal symptoms in adolescence or later psychosis in this large birth cohort. Learning deficits are not always associated with increased risk of psychosis, which might be due to, e.g. special support given in schools. The higher prevalence of prodromal symptoms in talented children may reflect a different kind of relationship of school success with prodromal symptoms compared to full psychoses.

Is there an association between cardiorespiratory fitness and stage of illness in psychotic disorders? A systematic review and meta-analysis

BACKGROUND

Clinical staging models describe where an individual exists on a continuum from asymptomatic at-risk states (Stage 0) through to established late-stage disease (Stage 4). We applied this framework to systematically assess evidence for any associations between objectively assessed cardiorespiratory fitness (CRF) and stage of psychosis.

METHOD

Nine electronic databases were searched for relevant publications from inception until October 31, 2019. Pooled effect sizes (Hedges' g and 95% confidence intervals (95% CI)) were estimated for differences in CRF for studies that reported mean oxygen uptake (max, peak, or predicted VO₂ in ml/kg/min).

RESULTS

Thirty-eight studies were eligible. Findings indicated that suboptimal CRF can be present at Stages 0 and 1. Meta-analyses of 22 studies demonstrated that CRF was significantly reduced in individuals classified between Stages 1 and 4 compared with matched or general population controls (g = -0.93; 95% CI -1.14, -0.71). Mean VO₂ was decreased by 28% in Stage 4 compared with Stage 1 (34.1 vs. 24.66 ml/kg/min); the largest effect size for CRF reduction was reported between Stages 2 and 3 (g = -1.16; 95% CI -1.31, -1.03).

CONCLUSIONS

Although not identifying direct causal links between clinical stage and CRF, using this framework may enhance understanding of co-associations between mental and physical health markers across the entire spectrum of psychosis. Limitations include lack of research on CRF in Stages 0 and 1 alongside problems determining stage in some studies. However, impaired CRF is reported in emerging psychosis, supporting calls that early intervention programmes should address both mental and physical wellbeing.

Does physical activity reduce the risk of psychosis? A systematic review and meta-analysis of prospective studies

Longitudinal prospective cohorts have suggested that physical activity (PA) may be a protective factor against psychosis and schizophrenia. However, no meta-analysis has been conducted. The study aims to examine the prospective relationship between PA and incident psychosis/schizophrenia. Major databases were searched from inception to July 2019 for prospective studies that calculated the odds ratio (OR) or the adjusted odds ratio (AOR) of incident psychosis/schizophrenia in people with higher PA against people with lower PA. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS). A random-effects meta-analysis was conducted, for OR and AOR, separately. Across 4 cohorts (N = 30,025 median males = 50%, median follow-up = 32 years), people with high self-reported PA (versus low PA) were at reduced odds of developing psychosis/schizophrenia (OR = 0.73, 95%CI 0.532 to 0.995, p = 0.047). Analysis including 2 cohorts presenting AOR were not statistically significant (AOR = 0.59, 95%CI 0.253 to 1.383, p = 0.226). Overall study quality was high (mean NOS = 7.0). The literature on the topic is scarce, whilst crude analysis suggests that PA may be a protective factor against the emergence of psychosis/schizophrenia, but when adjusting for covariates, the association is no longer significant. Further studies with objective physical activity and adjustment for confounders are needed.

Exercise and Schizophrenia

Schizophrenia is a psychiatric disorder characterized by distortions of thinking and perception, with no strictly pathognomonic symptoms that can be divided into positive, negative, and cognitive symptom domains. People with schizophrenia have, between others, a reduced life expectancy and cardiorespiratory and muscular fitness and increased risk of cardiovascular disease, metabolic syndrome, obesity, hypertension, and hyperlipidemia compared to the general population. Furthermore, the economic burden of mental disorders including schizophrenia is evident and it is expected to increase to more than double by 2030. Therefore, reducing the growing burden of mental disorders such as schizophrenia should be a health priority. Improved prevention and treatment are two key factors that may reduce the burden of schizophrenia. Pharmacological- and psychotherapy-based interventions have been traditionally considered for treating schizophrenia disorders; however, there is an increasing amount of scientific evidence confirming that physical activity and physical exercise should be highly considered in prevention and treatment of schizophrenia disorders. In this chapter, we aim to summarize and discuss the research progress of physical activity and exercise in prevention and treatment of schizophrenia disorder. Specifically, we summarized and discussed the research progress of the prognostic use of physical activity for incident schizophrenia; the importance of other outcomes typically improved by physical activity/exercise such as obesity and fitness (cardiorespiratory and muscular fitness) for future schizophrenia; the research progress of the evidence of the benefits of exercise in people with schizophrenia disorders differentiating between effects of exercise on varied health outcomes, cognitive functioning, and cardiorespiratory fitness; and finally the clinical practice recommendations.

Predictive validity of objective measures of physical fitness for the new onset of mental disorders in adolescents and young adults

AIM

To systematically review evidence that objectively assessed level of physical fitness is associated with future risk of adverse mental health outcomes during the peak age range for onset of adult mental disorders.

METHODS

Searches of Electronic databases (EBSCOhost, SPORTDISCUS, EMBASE, MedLINE, Cochrane database, CINAHL, PsychInfo, and Dissertation Abstracts), supplemented by hand searches of journals, conference proceedings and citations. Random-effects meta-analysis models were used to pool the intervention effects.

RESULTS

Eight studies of adolescents and young adults were included in the qualitative review and six studies derived from four independent cohorts were included in the statistical analyses. Most publications reported on large samples (including >1 million), but male conscripts were over-represented in the study cohorts; quality of included studies was modest, and heterogeneity was significant. Meta-analytic estimates were conducted for different adverse mental health outcomes, but all showed an inverse association between fitness and incidence of mental disorders or suicidality. Overall, higher level of physical fitness was associated with lower rates of onset of mental health problems (odds ratio: 0.59; 95% confidence intervals: 0.54, 0.65).

CONCLUSIONS

All eligible studies were undertaken since 2010, suggesting this is an emerging but unfinished field of research. The study design and methodological limitations indicate that the reported results should be treated with caution. However, if the meta-analytic findings are reliably replicated for new cohorts of males and females, they have implications for research into the prevention of non-communicable diseases, as our review suggests that interventions should target physical and mental health in equal measure.

Advances in clinical staging, early intervention, and the prevention of psychosis

The development of effective intervention and prevention strategies among individuals with psychosis risk syndromes may help to reduce symptomatology and conversion to a psychotic disorder. Although strides have been made in this area, more work is needed, particularly given the setbacks that remain (such as heterogeneity among this group). There has been a shift with the introduction of clinical staging models toward expanding current intervention and prevention efforts to a more developmental and transdiagnostic approach. With this, this article seeks to review treatments both recently and currently discussed in the staging literature, introduce advances in psychosis risk syndrome treatments that may be beneficial to consider in clinical staging heuristics, and pinpoint other promising options.

Appetite regulating hormones in first-episode psychosis: A systematic review and meta-analysis

We aimed to perform a systematic review and meta-analysis of appetite regulating hormones in patients with first-episode psychosis (FEP). Meta-analyses were conducted using random-effects models with Hedges' g as the effect size estimate. We identified 31 eligible studies, investigating the levels of 7 appetite regulating hormones (adiponectin, insulin, leptin, ghrelin, orexin, resistin and visfatin) in 1792 FEP patients and 1364 controls. The insulin levels in FEP patients were higher than in controls (g = 0.34, 95%CI: 0.19 - 0.49, p < 0.001), even considering only antipsychotic-naïve patients (g = 0.39, 95%CI: 0.12 - 0.66, p = 0.005). The severity of negative symptoms was positively associated with the effect size estimates (β = 0.08, 95%CI: 0.01 - 0.16, p = 0.030). Moreover, we found lower levels of leptin in antipsychotic-naïve FEP patients (g = -0.62, 95%CI: -1.11 - 0.12, p = 0.015). Impaired appetite regulation, in terms of elevated insulin levels and decreased leptin levels, occurs in early psychosis, before antipsychotic treatment. Hyperinsulinemia might be related to negative symptoms.

Promoting Mental Health and Wellness in Youth Through Physical Activity, Nutrition, and Sleep

The medical benefits to youth conferred by physical activity, balanced nutrition, and quality sleep have been increasingly encouraged by medical and mental health providers. Emerging evidence continues to reveal benefits for youth mental health and well-being, including for youth with psychiatric disorders. This evidence seems multifactorial through both neurobiological and psychosocial systems, with common mechanisms present between physical activity, nutrition, and sleep. This article reviews the benefits of optimizing physical activity, nutrition, and sleep; how to assess these lifestyle domains with patients and their parents; and appropriate interventions to optimize well-being in youth.

Psychiatric research in the Northern Finland Birth Cohort 1986 - a systematic review

The Northern Finland Birth Cohort 1986 is a large population-based birth cohort, which aims to promote health and wellbeing of the population. In this paper, we systematically review the psychiatric research performed in the cohort until today, i.e. at the age of 32 years of the cohort (2018). We conducted a systematic literature search using the databases of PubMed and Scopus and complemented it with a manual search. We found a total of 94 articles, which were classified as examining ADHD, emotional and behavioural problems, psychosis risk or other studies relating to psychiatric subjects. The articles are mainly based on two large comprehensive follow-up studies of the cohort and several substudies. The studies have often used also nationwide register data. The studies have found several early predictors for the aforementioned psychiatric outcomes, such as problems at pregnancy and birth, family factors in childhood, physical inactivity and substance use in adolescence. There are also novel findings relating to brain imaging and cognition, for instance regarding familial risk of psychosis in relation to resting state functional MRI. The Northern Finland Birth Cohort 1986 has been utilised frequently in psychiatric research and future data collections are likely to lead to new scientifically important findings.

Abbreviations: attention deficit hyperactivity disorder (ADHD); magnetic resonance imaging (MRI)

Is psychosis a multisystem disorder? A meta-review of central nervous system, immune, cardiometabolic, and endocrine alterations in first-episode psychosis and perspective on potential models

People with psychotic disorders show abnormalities in several organ systems in addition to the central nervous system (CNS); and this contributes to excess mortality. However, it is unclear how strong the evidence is for alterations in non-CNS systems at the onset of psychosis, how the alterations in non-CNS systems compare to those in the CNS, or how they relate to symptoms. Here, we consider these questions, and suggest potential models to account for findings. We conducted a systematic meta-review to summarize effect sizes for both CNS (focusing on brain structural, neurophysiological, and neurochemical parameters) and non-CNS dysfunction (focusing on immune, cardiometabolic, and hypothalamic-pituitary-adrenal (HPA) systems) in first-episode psychosis (FEP). Relevant meta-analyses were identified in a systematic search of Pubmed and the methodological quality of these was assessed using the AMSTAR checklist (A Measurement Tool to Assess Systematic Reviews). Case-control data were extracted from studies included in these meta-analyses. Random effects meta-analyses were re-run and effect size magnitudes for individual parameters were calculated, as were summary effect sizes for each CNS and non-CNS system. We also grouped studies to obtain overall effect sizes for non-CNS and CNS alterations. Robustness of data for non-CNS and CNS parameters was assessed using Rosenthal's fail-safe N. We next statistically compared summary effect size for overall CNSand overall non-CNS alterations, as well as for each organ system separately. We also examined how non-CNS alterations correlate CNS alterations, and with psychopathological symptoms. Case-control data were extracted for 165 studies comprising a total sample size of 13,440. For people with first episode psychosis compared with healthy controls, we observed alterations in immune parameters (summary effect size: g = 1.19), cardiometabolic parameters (g = 0.23); HPA parameters (g = 0.68); brain structure (g = 0.40); neurophysiology (g = 0.80); and neurochemistry (g = 0.43). Grouping non-CNS organ systems together provided an effect size for overall non-CNS alterations in patients compared with controls (g = 0.58), which was not significantly different from the overall CNS alterations effect size (g = 0.50). However, the summary effect size for immune alterations was significantly greater than that for brain structural (P < 0.001) and neurochemical alterations (P < 0.001), while the summary effect size for cardiometabolic alterations was significantly lower than neurochemical (P = 0.04), neurophysiological (P < 0.001), and brain structural alterations (P = 0.001). The summary effect size for HPA alterations was not significantly different from brain structural (P = 0.14), neurophysiological (P = 0.54), or neurochemical alterations (P = 0.22). These outcomes remained similar in antipsychotic naive sensitivity analyses. We found some, but limited and inconsistent, evidence that non-CNS alterations were associated with CNS changes and symptoms in first episode psychosis. Our findings indicate that there are robust alterations in non-CNS systems in psychosis, and that these are broadly similar in magnitude to a range of CNS alterations. We consider models that could account for these findings and discuss implications for future research and treatment.

What prevents youth at clinical high risk for psychosis from engaging in physical activity? An examination of the barriers to physical activity

BACKGROUND

Exercise has increasingly been proposed as a healthful intervention prior to and after the onset of psychosis. There is some evidence to suggest that youth at clinical high risk (CHR) for psychosis are less physically active and report more barriers to engaging in exercise; however, there has been relatively limited empirical work documenting this phenomenon, and to date, relationships between physical activity, barriers, and clinical phenomenology have been unclear.

METHODS

CHR (N = 51) and healthy control (N = 37) participants completed a structured clinical interview assessing attenuated psychotic symptoms and substance use, and an exercise survey that assessed current exercise practices, perceived physical fitness, and barriers related to engaging in exercise.

RESULTS

CHR youth engaged in less physical activity, exhibited lower perception of fitness, and endorsed more barriers related to motivation for exercise. The CHR group showed significant negative correlations where lower perceptions of fitness were associated with increased negative, disorganized, and general symptoms. Decreased frequency of activity was related to more barriers of motivation. Interestingly, greater symptomatology in the CHR group was associated with more barriers of self-perception and motivation for engaging in exercise. However, findings suggested a nuanced relationship in this area; for example, increased physical activity was associated with increased substance use.

CONCLUSIONS

The results of the current study support the notion that sedentary behavior is common in CHR youth, and more broadly, provide an impetus to target motivation through supervised exercise and fitness tracking to promote the health and well-being of CHR individuals.

Cognition, psychosis risk and metabolic measures in two adolescent birth cohorts

BACKGROUND

Psychoses, especially schizophrenia, are often preceded by cognitive deficits and psychosis risk states. Altered metabolic profiles have been found in schizophrenia. However, the associations between metabolic profiles and poorer cognitive performance and psychosis risk in the population remain to be determined.

METHODS

Detailed molecular profiles were measured for up to 8976 individuals from two general population-based prospective birth cohorts: the Northern Finland Birth Cohort 1986 (NFBC 1986) and the Avon Longitudinal Study of Parents and Children (ALSPAC). A high-throughput nuclear magnetic resonance spectroscopy platform was used to quantify 70 metabolic measures at age 15-16 years in the NFBC 1986 and at ages 15 and 17 years in ALSPAC. Psychosis risk was assessed using the PROD-screen questionnaire at age 15-16 years in the NFBC 1986 or the psychotic-like symptoms assessment at age 17 years in ALSPAC. Cognitive measures included academic performance at age 16 years in both cohorts and general intelligence and executive function in ALSPAC. Logistic regression measured cross-sectional and longitudinal associations between metabolic measures and psychosis risk and cognitive performance, controlling for important covariates.

RESULTS

Seven metabolic measures, primarily fatty acid (FA) measures, showed cross-sectional associations with general cognitive performance, four across both cohorts (low density lipoprotein diameter, monounsaturated FA ratio, omega-3 ratio and docosahexaenoic acid ratio), even after controlling for important mental and physical health covariates. Psychosis risk showed minimal metabolic associations.

CONCLUSIONS

FA ratios may be important in marking risk for cognitive deficits in adolescence. Further research is needed to clarify whether these biomarkers could be causal and thereby possible targets for intervention.

Medication and physical activity and physical fitness in severe mental illness

Anti-psychotic medication has emerged as the primary medical treatment for people with severe mental illness, despite the great risks involved in the use of this medication. In addition, this population suffers from problems of obesity, sedentary lifestyle and poor physical fitness, which is aggravated by the use of this type of medication. The objective of this study is to explore the influence of the most commonly used antipsychotics in this population (Olanzapine and Risperidone) on physical activity and the physical fitness of people with severe mental illness. Sixty-two people between 26 and 61 years of age with severe mental illness were assessed. All participants were evaluated with a battery of 11 physical tests to assess their physical fitness and with the IPAQ-short version questionnaire to determine their level of physical activity. The doses of Risperidone and Olanzapine were also evaluated in all participants. Significant differences were found for physical activity, with higher levels reported in those patients with severe mental illness who did not take any of these medications. Regarding physical fitness, significant differences were only found for the consumption of Risperidone, with better physical fitness levels seen in patients who did not consume this medication; on the other hand, for the consumption of Olanzapine, differences were found in muscular strength, balance and aerobic condition with better values in non-Olanzapine consumers compared with Olanzapine consumers.

Psychosocial factors associated with physical activity behavior among patients with psychosis

INTRODUCTION

Although physical activity helps to improve functioning and reduce the symptoms of mental illness, physical inactivity remains common in the mental illness population. This study aims to explore the associations between theoretical constructs in relation to physical activity behavior based on psychological theories to examine reasons for physical inactivity in psychosis population.

METHODS

One hundred and eighty one Chinese outpatients diagnosed with psychotic disorders were recruited for this cross-sectional study. Sociodemographic data and responses to questionnaires measuring self-efficacy, decisional balance, processes of change, and stages of change on physical activity habit were collected.

RESULTS

Ninety three subjects (51.4%) had the intention to engage in regular physical activity within the next six months. Significant differences were found in self-efficacy, pros of decisional balance and processes of change across the stages of change. Moreover, overall classification accuracy was 60.8% across the stages of change.

CONCLUSIONS

This study supports self-efficacy, pros of decisional balance and processes of change as useful factors in understanding physical activity behavior among patients with psychosis. Future promotions of regular physical activity can focus on improving self-efficacy, emphasizing on the benefits of regular physical activity and facilitating cognitive and behavior strategies from processes of change.

A randomized, 13-week study assessing the efficacy and metabolic effects of paliperidone palmitate injection and olanzapine in first-episode schizophrenia patients

BACKGROUND

This study was conducted to evaluate the efficacy and metabolic effects of paliperidone palmitate (PP) injections against oral olanzapine in first-episode schizophrenia (FES) patients.

METHODS

Eligible patients were randomized to receive PP or olanzapine. Efficacy assessments and weight-related parameters were assessed at baseline, weeks 1, 5, 9, and endpoint or at early withdrawal. Lipid, glucose, insulin and prolactin were evaluated at baseline and endpoint or at early withdrawal.

RESULTS

The Positive And Negative Syndrome Scale (PANSS) scores declined significantly after treatment in both groups. Significant increases in weight-related parameters from baseline to endpoint were shown in both groups. Although there was no significant difference in PANSS scores and weight-related parameters between the two groups through the whole 13-week study. The increased level of triglyceride and HOMA-IR at endpoint from baseline in the olanzapine group was higher than the PP group. There was a stronger elevation of prolactin level in the PP group.

CONCLUSIONS

In summary, PP and olanzapine showed similar improvement in the treatment of FES patients. This study also reinforced the necessity for regular monitoring of metabolic parameters in schizophrenia patients prescribed atypical antipsychotics. Clinical trial registration numbers: ChiCTR-IOR-14005304. Date of registration: 2014-10-11.

Total and differential white blood cell counts and hemodynamic parameters in first-episode psychosis

There is evidence for blood inflammatory abnormalities in patients with first-episode psychosis (FEP). The monocyte- and neutrophil-to-lymphocyte ratios (MLR; NLR) are markers of inflammation and endothelial dysfunction, and predictors of cardiovascular disease, the leading cause of death in schizophrenia. We investigated relationships between white blood cell (WBC) counts and hemodynamic parameters associated with cardiovascular disease risk in 25 subjects age 18-50 hospitalized for FEP and 44 controls. Subjects had a blood draw, vital signs, and medical history. Patients with FEP had significantly higher NLR, MLR, pulse pressure, and rate pressure product (RPP) than controls (p < 0.05 for each), after controlling for potential confounders. In linear regression analyses, higher monocytes were a significant predictor of higher pulse pressure (p = 0.033) and higher MLR predicted RPP at the trend level (p = 0.051) in FEP, after controlling for potential confounders. To our knowledge, ours is the first report of increased RPP, a measure of myocardial workload, in FEP. We also replicated findings of increased NLR, MLR and pulse pressure in FEP. Our findings underscore that measurement of routine vital signs and blood total and differential WBC counts are germane to the clinical care of patients with psychosis as markers of cardiovascular disease risk.

Cholesterol and triglyceride levels in first-episode psychosis: systematic review and meta-analysis

BackgroundThe extent of metabolic and lipid changes in first-episode psychosis (FEP) is unclear.AimsTo investigate whether individuals with FEP and no or minimal antipsychotic exposure show lipid and adipocytokine abnormalities compared with healthy controls.MethodWe conducted a meta-analysis of studies examining lipid and adipocytokine parameters in individuals with FEP and no or minimal antipsychotic exposure v. a healthy control group. Studies reported fasting total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides and leptin levels.ResultsOf 2070 citations retrieved, 20 case-control studies met inclusion criteria including 1167 patients and 1184 controls. Total cholesterol and LDL cholesterol levels were significantly decreased in patients v. controls, corresponding to an absolute reduction of 0.26 mmol/L and 0.15 mmol/L respectively. Triglyceride levels were significantly increased in the patient group, corresponding to an absolute increase of 0.08 mmol/L. However, HDL cholesterol and leptin levels were not altered in patients v. controls.ConclusionsTotal and LDL cholesterol levels are reduced in FEP, indicating that hypercholesterolaemia in patients with chronic disorder is secondary and potentially modifiable. In contrast, triglycerides are elevated in FEP. Hypertriglyceridaemia is a feature of type 2 diabetes mellitus, therefore this finding adds to the evidence for glucose dysregulation in this cohort. These findings support early intervention targeting nutrition, physical activity and appropriate antipsychotic prescription.

A Supervised Exercise Intervention for Youth at Risk for Psychosis: An Open-Label Pilot Study

OBJECTIVE

A rapidly accumulating body of research suggests that exercise can improve symptoms and well-being in patients suffering from psychosis. Exercise may also promote neurogenesis in the hippocampus, a structure that plays an important role in the pathophysiology of psychosis. To date, there has not been an intervention focused on exercise prior to the onset of psychosis, a critical time for prevention of more serious illness.

METHODS

In this pilot study, 12 young adults at ultrahigh risk (UHR) for psychosis were enrolled in a 12-week open-label exercise intervention. Participants were randomly assigned to exercise 2 or 3 times each week and exercised between 65% and 85% of maximum oxygen capacity (Vo2max) for 30 minutes each session under the supervision of an exercise physiologist. Positive and negative symptoms, social and role functioning, performance on neurocognitive tests, cardiovascular fitness, and hippocampal structure and functional connectivity were evaluated before and after the trial.

RESULTS

A total of 9 participants completed the exercise intervention. Participants showed improved positive and negative symptoms and social and role functioning; improvement in multiple areas of cognition; and increased functional connectivity between the left hippocampus and occipital cortex after 12 weeks of exercise.

CONCLUSIONS

The results of this study suggest that exercise interventions are feasible in a UHR sample and may promote improvement in clinical, social, and cognitive domains as well as changes to brain function in regions impacted by the development of psychosis. These findings set the stage for an ongoing phase 2 randomized controlled trial.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT02155699.

Longitudinal association between physical activity engagement during adolescence and mental health outcomes in young adults: A 21-year birth cohort study

OBJECTIVE

Previous studies provide mixed evidence that physical activity engagement (PAE) in adolescence is associated with later mental health outcomes. This study aimed to examine the association between PAE at age 14 and mental health outcomes at age 21 using a large birth cohort study.

MATERIAL AND METHODS

Prospective data from the Mater-University of Queensland Study of Pregnancy, consisting of 3493 young adults, were analyzed. PAE at age 14 was estimated using self-report, and participants were categorized into; (1) frequent, (2) infrequent, or (3) no PAE group. Mental health outcomes at age 21 consisted of; (1) common mental disorders, (2) psychosis-related outcomes, and, (3) emotional and behavioral problems. The association between PAE in adolescence and later mental health outcomes in young adulthood was examined using logistic regression, adjusted for age, sex, body mass index, and adolescent psychopathology.

RESULTS

No PAE at age 14 was associated with the increased likelihood of lifetime diagnosis of any affective disorder, elevated delusional ideation, and endorsement of visual perceptual disturbance at age 21. Conversely, infrequent PAE at age 14 was associated with the decreased likelihood of subsequent lifetime diagnosis of any substance use disorder.

CONCLUSION

Our findings suggest that lack of PAE in adolescence influences some, but not all, later mental health outcomes. Interventions to increase PAE in adolescence may represent an opportunity to prevent future mental health problems.

Mental Health Nurses Attitudes and Practice Toward Physical Health Care in Jordan

Patients with mental illnesses are at high risk for physical disorders and death. The aim of this study is to describe mental health nurses' attitudes and practice toward physical health care for patients with mental illnesses. A descriptive cross-sectional design was used to collect data using self- reported questionnaire from 202 mental health nurses working in mental health settings in Jordan. The study adopted translated version of Robson and Haddad Physical Health Attitudes Scale to the Arabic language. There was significant positive correlation between the participants' positive attitudes and their current practice (r = .388, p = .000), mental health nurses who have more positive attitudes regarding physical health care involved physical health care more in their current practice. Mental health nurses' attitudes affect the quality of care provided to patients with mental illnesses. The results provide implications for practice, education, and research.

Investigating the link between drug-naive first episode psychoses (FEPs), weight gain abnormalities and brain structural damages: Relevance and implications for therapy

Evidence suggests that obesity and overweight may be associated with severe brain structural abnormalities and poor cognitive and functional outcomes in the general population. Despite these observations and the high prevalence of weight gain abnormalities in patients with psychosis spectrum disorders (PSDs), no studies have investigated the impact that these metabolic disturbances may have on brain structures and development in the earliest stages of PSDs. In the present review we shed light on the association between weight gain and brain structural abnormalities that may affect the course of illness in drug-naïve FEPs. Given the lack of studies directly investigating this issue, we firstly identified and critically evaluated the literature assessing weight gain abnormalities and gray or white matter (GM, WM) volumes (either globally or in specific regions of interest) in otherwise healthy obese/overweight adolescents and young adults. We then compared the results of this systematic review with those of two recent meta-analysis investigating GM and WM abnormalities in drug-naïve FEPs. Weight gain in otherwise healthy subjects was consistently associated with frontal and temporal GM atrophy and with reduced integrity of WM in the corpus callosum. Of relevance, all these brain regions are affected in drug-naïve FEPs, and their integrity is associated with clinical, cognitive and functional outcomes. The underlying mechanisms that may explain the association between weight gain, adiposity, and brain damage in both healthy subjects and drug-naïve FEPs are widely discussed. On the basis of this knowledge, we tried: a) to deduce an integrative model for the development of obesity in psychosis spectrum disorders; b) to identify the key vulnerability factors underlying the association between weight gain and psychosis; c) to provide information on new potential targets of intervention.

Exercise Treatments for Psychosis: A Review

Schizophrenia is a devastating mental illness that has profound effects on a person's health and quality of life. Exercise represents a promising new treatment option that may supplement current psychosocial and pharmacological interventions for psychosis. A large body of work suggests that exercise can improve cardio-metabolic and health behavior and facilitate neurogenesis in areas of the brain that are notably impacted by psychosis. Recent efforts to incorporate exercise as either stand-alone or adjunctive treatment for individuals with schizophrenia range from yoga and light stretching to moderately intense walking, bike riding, or team sports. These interventions suggest that moderately intense exercise may be beneficial for improving both positive and negative symptomatology, cognition and functioning. Indeed, exercise may be beneficial for decreasing risk factors for a wide range of health problems often observed in patients with schizophrenia, including weight gain and metabolic syndrome as well as tobacco and substance use. Given the positive results from interventions in schizophrenia patients, there is an impetus for incorporating exercise in the early stages of the disorder. Notably, individuals at ultrahigh risk (UHR) for psychosis report more sedentary behavior and perceive less benefit from exercise; interventions prior to the onset of the disorder may be helpful for increasing health behaviors, perhaps delaying or preventing the onset of psychosis. Taken together, for individuals with psychosis, exercise may provide holistic benefits for the neural to the social impairments.

Impaired Glucose Homeostasis in First-Episode Schizophrenia: A Systematic Review and Meta-analysis

IMPORTANCE

Schizophrenia is associated with an increased risk of type 2 diabetes. However, it is not clear whether schizophrenia confers an inherent risk for glucose dysregulation in the absence of the effects of chronic illness and long-term treatment.

OBJECTIVE

To conduct a meta-analysis examining whether individuals with first-episode schizophrenia already exhibit alterations in glucose homeostasis compared with controls.

DATA SOURCES

The EMBASE, MEDLINE, and PsycINFO databases were systematically searched for studies examining measures of glucose homeostasis in antipsychotic-naive individuals with first-episode schizophrenia compared with individuals serving as controls.

STUDY SELECTION

Case-control studies reporting on fasting plasma glucose levels, plasma glucose levels after an oral glucose tolerance test, fasting plasma insulin levels, insulin resistance, and hemoglobin A1c (HbA1c) levels in first-episode antipsychotic-naive individuals with first-episode schizophrenia compared with healthy individuals serving as controls. Two independent investigators selected the studies.

DATA EXTRACTION

Two independent investigators extracted study-level data for a random-effects meta-analysis. Standardized mean differences in fasting plasma glucose levels, plasma glucose levels after an oral glucose tolerance test, fasting plasma insulin levels, insulin resistance, and HbA1c levels were calculated. Sensitivity analyses examining the effect of body mass index, diet and exercise, race/ethnicity, and minimal (≤2 weeks) antipsychotic exposure were performed.

DATA SYNTHESIS

Of 3660 citations retrieved, 16 case-control studies comprising 15 samples met inclusion criteria. The overall sample included 731 patients and 614 controls. Fasting plasma glucose levels (Hedges g = 0.20; 95% CI, 0.02 to 0.38; P = .03), plasma glucose levels after an oral glucose tolerance test (Hedges g = 0.61; 95% CI, 0.16 to 1.05; P = .007), fasting plasma insulin levels (Hedges g = 0.41; 95% CI, 0.09 to 0.72; P = .01), and insulin resistance (homeostatic model assessment of insulin resistance) (Hedges g = 0.35; 95% CI, 0.14 to 0.55; P = .001) were all significantly elevated in patients compared with controls. However, HbA1c levels (Hedges g = -0.08; CI, -0.34 to 0.18; P = .55) were not altered in patients compared with controls.

CONCLUSIONS AND RELEVANCE

These findings show that glucose homeostasis is altered from illness onset in schizophrenia, indicating that patients are at increased risk of diabetes as a result. This finding has implications for the monitoring and treatment choice for patients with schizophrenia.

Effects of childhood and adolescence physical activity patterns on psychosis risk-a general population cohort study

Schizophrenia spectrum disorders are associated with high morbidity and mortality in somatic diseases. The risk factors of this excess mortality include, e.g., obesity, dietary factors, and physical inactivity, especially after the onset of psychosis, but there are limited early developmental data on these factors in individuals who later develop psychosis. A population-based cohort study "Cardiovascular Risk of Young Finns" started in 1980 with 3596 children and adolescents from six different age groups (3, 6, 9, 12, 15, and 18 years). Cardiovascular health parameters, including questionnaire of physical activity before first hospitalization (≤18 years), were studied in 1980, 1983, and 1986. All psychiatric diagnoses of the participants were derived from the Finnish Hospital Discharge Register up to the year 2012. We identified diagnostic groups of non-affective psychosis (n = 68, including a schizophrenia subgroup, n = 41), personality disorders (n = 43), affective disorders (n = 111), and substance-related disorders (n = 49), based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Groups were compared with controls with no psychiatric diagnoses (n = 3325). Sex, age, body mass index, birth weight, non-preterm birth, and mother's mental disorders were included in the statistical model. Low physical activity in childhood and adolescence (9-18 years) independently predicted later development of non-affective psychosis. Lower physical activity index (relative risk 1.26 [1.1-1.5]), lower level of common activity during leisure time (relative risk 1.71 [1.2-2.5]), and non-participation in sports competitions (relative risk 2.58 [1.3-5.3]) were associated with a higher risk for later non-affective psychosis (expressed as increase in relative risk per physical activity unit). The findings were even stronger for schizophrenia, but no such link was observed for other diagnoses. The cause of low physical activity in premorbid/prodromal phase is likely to be multifactorial, including deviant motor and cognitive development. The results provide a rationale for including exercise and physical activity interventions as a part of psychosis prevention programs.

Physical health promotion for young people at ultra-high risk for psychosis: An application of the COM-B model and behaviour-change wheel

People with psychotic illnesses, such as schizophrenia, have high rates of unhealthy lifestyle factors, such as smoking and physical inactivity. Young people who seek help for mental health care, particularly those at high risk for psychosis, often also display high rates of these unhealthy behaviours. Although healthy living interventions have been applied to people with established psychosis, no attempt has been made to offer them to young people at risk for developing psychosis, despite potential benefits to mental and physical health. We propose that the COM-B model (consisting of capability, opportunity and motivation) and behaviour-change wheel might be an appropriate framework that mental health nurses and other health professionals could apply. Using a systematic and theoretically-based approach to intervention development could result in effective methods of health promotion in this group. Further training and development for mental health nurses could encourage a greater integration of mental and physical health care.

Impact of antipsychotic medication on physical activity and physical fitness in adolescents: An exploratory study

Antipsychotics are used increasingly in adolescents for a range of psychiatric disorders. The aim of the current study was to investigate whether physical activity levels and physical fitness of adolescent inpatients treated with antipsychotic medication, differs from either (i) antipsychotic naïve adolescents with mental health problems and, (ii) healthy controls. All participants completed the Physical Activity Questionnaire for Adolescents, the Positive-and-Negative-Affect-Schedule and performed the Eurofit test battery. Adolescents with mental health problems (irrespective of antipsychotic medication) were significantly (P<0.05) less physically active and had an impaired whole body balance, running speed and cardiovascular endurance compared to healthy controls (n=15, 8♂, 15.9±1.3 years). Adolescents treated with antipsychotic medication (n=15, 8♂, 15.5±1.3 years) were less physically active and had an impaired whole body balance compared with antipsychotic naïve adolescents (n=15, 8♂, 15.7±1.4 years). Given the overwhelming deleterious impact of physical inactivity and low physical fitness on physical and mental health outcomes, interventions specifically targeting physical activity and physical fitness among adolescents experiencing mental illness, both treated with, and not treated with antipsychotic medication are warranted as a priority. Antipsychotic medication should be considered as a risk factor for physical inactivity and poor physical fitness.

Body mass index and brain white matter structure in young adults at risk for psychosis - The Oulu Brain and Mind Study

Antipsychotic medications and psychotic illness related factors may affect both weight and brain structure in people with psychosis. Genetically high-risk individuals offer an opportunity to study the relationship between body mass index (BMI) and brain structure free from these potential confounds. We examined the effect of BMI on white matter (WM) microstructure in subjects with familial risk for psychosis (FR). We used diffusion tensor imaging and tract-based spatial statistics to explore the effect of BMI on whole brain FA in 42 (13 males) participants with FR and 46 (16 males) control participants aged 20-25 years drawn from general population-based Northern Finland Birth Cohort 1986. We also measured axial, radial and mean diffusivities. Most of the participants were normal weight rather than obese. In the FR group, decrease in fractional anisotropy and increase in radial diffusivity were associated with an increase in BMI in several brain areas. In controls the opposite pattern was seen in participants with higher BMI. There was a statistically significant interaction between group and BMI on FA and radial and mean diffusivities. Our results suggest that the effect of BMI on WM differs between individuals with FR for psychosis and controls.

A randomized controlled trial on the psychophysiological effects of physical exercise and Tai-chi in patients with chronic schizophrenia

The chronic and prevalent natures of schizophrenia result in long-term institutionalization for the patients. Conventional treatment of anti-psychotic medication on management of psychotic symptoms often brings on severe side effects and reduces patients' well-being. Tai-chi is a mind-body exercise that underscores motor coordination and relaxation. This 3-arm randomized controlled trial investigated the psychophysiological benefits of Tai-chi on 153 chronic schizophrenia patients, who were recruited from a mental health rehab complex and randomized into Tai-chi, exercise, or waitlist control groups. Both intervention groups received 12weeks of specific intervention plus standard medication received by the controls. All participants completed psychiatric interviews, self-report questionnaires, performance tasks, and salivary cortisol measures at baseline, 3-month, and 6-month follow-up on psychotic symptoms, motor coordination, memory, daily living function, and stress. Multigroup latent growth modeling was used to evaluate the intervention effects on the outcomes. Compared to controls, the Tai-chi group showed significant decreases in motor deficits and increases in backward digit span and mean cortisol, while the exercise group displayed significant decreases in motor deficits, negative and depression symptoms and increases in forward digit span, daily living function, and mean cortisol. The two interventions did not show significantly different therapeutic effects, except for fewer symptom manifestations in the exercise group. These results suggest psychophysiological benefits for Tai-chi on chronic schizophrenia patients in terms of motor coordination and memory. Though both Tai-chi and exercise groups tended to manifest fewer symptoms than the control group, the exercise group showed better symptoms management than the Tai-chi group.

Cardiometabolic risk factors in young people at ultra-high risk for psychosis: A systematic review and meta-analysis

BACKGROUND

The physical health of people with schizophrenia is poor, and associated with increased morbidity and mortality. Unhealthy lifestyles and side-effects of antipsychotic medication contribute to cardiometabolic dysfunction. Yet it is unclear when this unhealthy profile starts. We aimed to see if people at ultra-high risk for psychosis (UHR) have increased rates of cardiometabolic risk factors.

METHOD

An electronic search of MEDLINE, PsycINFO, Embase and the Cochrane Central Register of Controlled Trials was conducted on 1st May 2015 using terms associated with the ultra-high risk state and health. Eligible studies were peer-reviewed English language research articles with populations that met at-risk diagnostic criteria and reported cardiometabolic risk factors. A meta-analysis was conducted on smoking data, the cardiometabolic risk factor that yielded the most studies.

RESULTS

Forty-seven eligible studies were identified. UHR samples had low levels of physical activity, and high rates of smoking and alcohol abuse compared with controls. No differences were found for body mass index. An overall pooled rate of smoking for UHR participants was 33% (95% CI=0.24-0.42) and significantly more UHR individuals smoked compared with controls with a pooled odds ratio of 2.3 (P<0.05; 95% CI=-1.48-3.48).

CONCLUSIONS

UHR samples display cardiometabolic risk factors which are largely modifiable. The UHR phase is an important opportunity for early intervention services to improve physical health.

Impaired Aerobic Endurance and Muscular Strength in Substance Use Disorder Patients: Implications for Health and Premature Death

Although substance use disorder (SUD) patients are documented to have an inactive lifestyle, which is associated with cardiovascular disease, other lifestyle-related diseases and premature death, evidence regarding their aerobic endurance and muscular strength is limited. Therefore, the authors aimed to evaluate directly assessed maximal oxygen consumption, walking efficiency, as well as maximal strength in a group of SUD patients.A total of 44 SUD patients in residential treatment, 31 men (31 ± 8 years) and 13 women (34 ± 10 years), were included and completed the physical testing. The patients were compared with an age- and sex-matched reference group.Male and female SUD patients exhibited a maximal oxygen consumption of 44.6 ± 6.2 and 33.8 ± 6.6 mL· min kg, respectively. This was significantly lower than the reference group, 15% (P = 0.03) for men and 25% (P = 0.001) for women. In addition, the SUD patients had a 13% significantly reduced walking efficiency (P = 0.02), compared with healthy controls. The impairments in aerobic endurance were accompanied by significant reductions in maximal strength of 30% (P = 0.001) and 33% (P = 0.01) for men and women, respectively. In combination, these results imply that SUD patients have impaired endurance and muscular strength compared with what is typically observed in the population, and consequently suffer a higher risk of developing cardiovascular and other lifestyle-related diseases and early death. Effective physical exercise should be advocated as an essential part of the clinical practice of SUD treatment to improve the patient's health and consequently reduce the costs because of the high use of emergency departments, hospital, and medical care.

Psychometric validation of the consensus five-factor model of the Positive and Negative Syndrome Scale

BACKGROUND

The Positive and Negative Syndrome Scale (PANSS) is widely used for clinical assessment of symptoms in schizophrenia. Instead of the traditional pyramidal model, recent literature supports the pentagonal model for the dimensionality of the PANSS.

AIM

The present study aimed to validate the consensus five-factor model of the PANSS and evaluate its convergent validity.

METHODS

Participants were 146 Chinese chronic schizophrenic patients who completed diagnostic interviews and cognitive assessments. Exploratory structural equation modeling (ESEM) was performed to investigate the dimensionality of the PANSS. Covariates (age, sex, and education level) and concurrent outcomes (perceived stress, memory, daily living functions, and motor deficits) were added in the ESEM model.

RESULTS

The results supported the consensus 5-factor underlying structure, which comprised 20 items categorized into positive, negative, excitement, depression, and cognitive factors with acceptable reliability (α=.69-.85) and strong factor loadings (λ=.41-.93). The five factors, especially the cognitive factor, showed evident convergent validity with the covariates and concurrent outcomes.

CONCLUSION

The results support the consensus five-factor structure of the PANSS as a robust measure of symptoms in schizophrenia. Future studies could explore the clinical and practical utility of the consensus five-factor model.

Exercise practices in individuals at clinical high risk of developing psychosis

AIM

Recent research suggests aerobic exercise has a positive impact on symptoms and cognition in psychosis. Because individuals with psychosis are at risk of weight gain and the resultant metabolic side-effects, developing effective exercise programmes is of interest. Furthermore, this may be a useful intervention for those who are at risk of developing psychosis, that is, those at clinical high risk (CHR). The aim of this initial exploratory project was to examine the role of exercise in participants at CHR for psychosis.

METHODS

A comprehensive questionnaire was developed to assess current physical activity involvement; exercise levels in terms of frequency, intensity and duration; and perceived fitness levels. Reported barriers to exercise and reasons for exercising were also considered. Eighty participants, 40 CHR and 40 healthy controls, were assessed with this questionnaire.

RESULTS

Overall, both groups were involved in a wide range of physical activity. Healthy controls reported higher levels of participation in indoor/outdoor activities and strength and/or flexibility training. They also exercised more frequently, more intensely and reported higher perceived fitness levels than CHR participants. Levels of exercise were unrelated to clinical symptoms and functioning in CHR participants. CHR youth reported more barriers to exercise and less positive reasons for exercising that were related to self-perception.

CONCLUSION

The results suggest that exercise should be investigated further in the CHR population as it may have treatment implications.

LIFEHOPE.EU: lifestyle and healthy outcome in physical education

ACCESSIBLE SUMMARY

●  People with severe mental illnesses (SMIs) suffer from health inequities and have a higher mortality rate, resulting from a sedentary lifestyle and a high prevalence of undiagnosed and untreated metabolic and cardiovascular risk factors. Cognitive deficits due to SMI symptoms may affect their ability to engage in a healthier lifestyle. ●  Programmes for a healthier lifestyle with physical activity components may improve mental and physical health for people with SMIs. In order to increase physical activity among this population, a new approach was developed as an integrated part of daily care. ●  This programme included a cognitive support in the shape of cognitive adaptation training (CAT) in order to address cognitive impairments, and provided education and individualized support in natural nursing environments to help individuals engage in physical activity (PHYS) and dietary changes (PHYS/CAT).

ABSTRACT

People with severe mental illness (SMIs) are more prone to physical illnesses, increased mortality and cognitive impairments, all of which negatively influence their daily lives. Physical activity (PHYS) programmes have helped alleviate SMI. LIFEHOPE is an ongoing research project with the purpose of developing a sustainable lifestyle intervention for physical and mental health. PHYS/cognitive adaptation training (CAT) is a newly created lifestyle intervention that provides group education and is based on CAT. It provides individualized support for PHYS and dietary change in a natural nursing environment. The aim of this study was to obtain further knowledge for developing a sustainable lifestyle programme by exploring psychiatric clients' experiences with PHYS and lifestyle habits, which we did by interviewing a local reference group, community mental healthcare users and community mental healthcare workers. Then, we developed a lifestyle programme for people with SMI using information obtained from these focus group interviews. Our results suggest that there is a need for support and education, as well as active interventions, in carrying out PHYS and dietary changes among people with SMIs, and the PHYS/CAT may be a useful strategy.

The psychophysiological effects of Tai-chi and exercise in residential schizophrenic patients: a 3-arm randomized controlled trial

BACKGROUND

Patients with schizophrenia are characterized by high prevalence rates and chronicity that often leads to long-term institutionalization. Under the traditional medical model, treatment usually emphasizes the management of psychotic symptoms through medication, even though anti-psychotic drugs are associated with severe side effects, which can diminish patients' physical and psychological well-being. Tai-chi, a mind-body exercise rooted in Eastern health philosophy, emphasizes the motor coordination and relaxation. With these potential benefits, a randomized controlled trial (RCT) is planned to investigate the effects of Tai-chi intervention on the cognitive and motor deficits characteristic of patients with schizophrenia.

METHODS/DESIGN

A 3-arm RCT with waitlist control design will be used in this study. One hundred and fifty three participants will be randomized into (i) Tai-chi, (ii) exercise or (iii) waitlist control groups. Participants in both the Tai-chi and exercise groups will receive 12-weeks of specific intervention, in addition to the standard medication and care received by the waitlist control group. The exercise group will serve as a comparison, to delineate any unique benefits of Tai-chi that are independent of moderate aerobic exercise. All three groups will undergo three assessment phases: (i) at baseline, (ii) at 12 weeks (post-intervention), and (iii) at 24 weeks (maintenance). All participants will be assessed in terms of symptom management, motor coordination, memory, daily living function, and stress levels based on self-perceived responses and a physiological marker.

DISCUSSION

Based on a promising pilot study conducted prior to this RCT, subjects in the Tai-chi intervention group are expected to be protected against deterioration of motor coordination and interpersonal functioning. They are also expected to have better symptoms management and lower stress level than the other treatment groups.

TRIAL REGISTRATION

The trail has been registered in the Clinical Trials Center of the University of Hong Kong (HKCTR-1453).

Independent and combined influence of the components of physical fitness on academic performance in youth

OBJECTIVE

To examine the independent and combined associations of the components of physical fitness with academic performance among youths.

STUDY DESIGN

This cross-sectional study included a total of 2038 youths (989 girls) aged 6-18 years. Cardiorespiratory capacity was measured using the 20-m shuttle run test. Motor ability was assessed with the 4×10-m shuttle run test of speed of movement, agility, and coordination. A muscular strength z-score was computed based on handgrip strength and standing long jump distance. Academic performance was assessed through school records using 4 indicators: Mathematics, Language, an average of Mathematics and Language, and grade point average score.

RESULTS

Cardiorespiratory capacity and motor ability were independently associated with all academic variables in youth, even after adjustment for fitness and fatness indicators (all P≤.001), whereas muscular strength was not associated with academic performance independent of the other 2 physical fitness components. In addition, the combined adverse effects of low cardiorespiratory capacity and motor ability on academic performance were observed across the risk groups (P for trend<.001).

CONCLUSION

Cardiorespiratory capacity and motor ability, both independently and combined, may have a beneficial influence on academic performance in youth.

Selection, use and psychometric properties of physical activity measures to assess individuals with severe mental illness: a narrative synthesis

This research provides a critical consideration of the outcome measures used to assess physical activity in individuals with severe mental illness. A narrative synthesis was utilised to provide a simple juxtapose of the current research. A sensitive topic-based search strategy was conducted in order to identify studies that met the eligibility criteria. Fifty two studies met the inclusion criteria and 5 were identified specially as validation studies. The current research identified several methodological shortcomings. The justification and choice of outcome measure used is often weak and only five studies have validated a specific outcome measure of physical activity. Within these validation studies, the validation process often lacked a consideration of agreement between measures. Accelerometers have been most frequently used as a criterion measure, notably the RT3 tri-axial accelerometer. Objective based measures may be best placed to consider physical activity levels, although, methodological considerations for the utilization of such tools is required. Self-report questionnaires have benefits for use in this population but require further validation. Researchers and clinicians need to carefully consider what outcome measure they are using and be aware of the development, scope and purpose of that measure.

Effects of daily energy expenditure on academic performance of elementary students in Taiwan

AIM

The objective of the study was to investigate the potential effects of daily energy expenditure on the academic performance (AP) of elementary schoolchildren, the results of which will be used as the basis of planning physical activity (PA) for children in the future.

METHODS

Participants were collected from 4th to 6th grade children at an elementary school in southern Taiwan. The effective sample data size was 1065 (79.8%; 528 boys and 537 girls). Daily mean energy expenditure was obtained using the 3 Day Physical Activity Recall (3-DPAR), and the intensive activities degrees of physical activity were categorized into lowest PA, middle PA, and highest PA group, and academic performance assessed with weighted academic score.

RESULTS

The significant effect on the academic performance of schoolchildren was only in energy expenditure but not for sexes and tutorials attended. All students in the middle PA group performed better academically than those in the highest PA group. After controlling sexes, male students in the middle PA group performed better than other groups; female students in the lowest PA group performed better than other groups.

CONCLUSION

These results may be consulted by schools, academic faculties, and parents in setting up exercise plans for children.

[Psychosis, cardiovascular risk and associated mortality: are we on the right track?]

Patients with psychotic disorders have a higher risk of early mortality. In addition to unnatural causes (accidents, suicide), death due to cardiovascular (CV) reasons is two to four times more prevalent in these patients than in the general population. This non-systematic review of MEDLINE aims to clarify the role of all the determining factors are involved. Psychotic disorders are related to unhealthy life habits such as smoking, poor diet and physical inactivity. Neuroleptic drugs have also been studied as triggers of obesity and metabolic syndrome. Therefore, psychotic patients seem predisposed to suffer from several of the «classic» CV risk factors. It is not surprising that their scores on the CV risk scales (Framingham, SCORE) are higher than the general population. We also found publications that showed poorer management of primary and secondary prevention of CV disease. In addition, some biochemical factors (plasma levels of cortisol, ACTH, homocysteine, PCR) may indicate a vulnerability in psychosis per se, as well as the findings on hyperglycemia and insulin resistance in psychotic "drug naive" patients. These "non-classical" factors could alter the validity of CV risk scales designed for the general population. Furthermore, antipsychotic drugs could control intrinsic factors of psychosis (they have shown to reduce global mortality), and their role in CV mortality is not clear.

Mental health and social participation skills of wheelchair basketball players: a controlled study

The aim of this study was to assess differences in psychological well-being, symptomatic psychological disorders and social participation, between competitive wheelchair basketball participants and those non-participants. Forty-six wheelchair participants, 24 Basketball players (aged 35.60 ± 7.56) and 22 non-players (aged 36.20 ± 6.23), completed three validated self-report questionnaires: Participation Scale (PS), Psychological Well-Being Scale [PWBS] and Symptom Checklist 90 R [SCL-90-R]. ANOVA showed significant overall differences between the two groups. The social restriction score, evaluated by PS, was significantly higher in the non-basketball participants (p=0.00001) than the basketball participants. The PWB Scale showed significant differences in all 6 dimensions: positive relations with others, environmental mastery, personal growth, purpose in life and self-acceptance (p<0.01), and autonomy (p<0.05), with better scores in the basketball participants. The SCL-90-R scores were significantly lower for the basketball group in the following 6 symptomatic dimensions: depression, phobic anxiety, and sleep disorder (p<0.01), somatization, interpersonal sensitivity and psychoticism (with p<0.05). It was concluded that competitive wheelchair basketball participants showed better psychological well-being and social skills than those non-participants.

Relationships between physical fitness, physical activity, smoking and metabolic and mental health parameters in people with schizophrenia

Low physical fitness has been recognised as a prominent behavioural risk factor for cardiovascular diseases (CVD) and metabolic syndrome (MetS), and as an independent risk factor for all-cause mortality. No studies have systematically assessed physical fitness compared with a matched health control group in patients with schizophrenia. Eighty patients with schizophrenia and 40 age-, gender- and body mass index (BMI)-matched healthy volunteers were included. All participants performed an Eurofit test battery and filled out the International Physical Activity Questionnaire. Patients additionally had a fasting metabolic laboratory screening and were assessed for psychiatric symptoms. Patients with schizophrenia demonstrated significant differences from controls in whole body balance, explosive leg muscle strength, abdominal muscular endurance, and running speed. Inactive patients scored worse on most Eurofit items than patients walking for at least 30min per day. Low physical fitness was associated with illness duration, smoking, the presence of MetS and more severe negative, depressive and cognitive symptoms. Less physically active patients who smoke and suffer from high levels of negative, depressive and/or cognitive symptoms might benefit from specific rehabilitation interventions aimed at increasing physical fitness.