Physical therapy for reducing arousal and mechanical restraint among in-patients with mania.

BACKGROUND: From 2003 to 2013 the number of patients exposed to mechanical restraint in Danish psychiatric hospitals was increased. Since, a great effort has been done to reduce mechanical restraint. OBJECTIVES: The aim of this study was to assess whether physical therapy could lower the level of arousal and reduce mechanical restraint among patients with mania. METHODS: 170 patients admitted with mania at Aarhus University Hospital were offered physical therapy during the study period from 2017 to 2018. Patients reported their experienced level of arousal before and after physical therapy, rating feelings of tension, ability to be at rest, and feelings of irritability/aggression on Visual Analog Scales. Further, the number of manic patients exposed to mechanical restraint in this period was compared with the two previous years and with patients with other diagnoses. RESULTS: Patients' level of arousal was significantly reduced after receiving physical therapy. Further, the study showed a significant reduction in mechanical restraint among patients with mania from 2015 to 2017. CONCLUSION: The results indicate that physical therapy lowers the level of arousal and it is possible that physical therapy contributed to a reduction in mechanical restraint among manic patients. However, the study-design does not allow for confirming this causality.

Physical activity and anomalous bodily experiences in patients with first-episode schizophrenia.

BACKGROUND: Low physical activity is strongly correlated with metabolic syndrome (MetS) and poor physical health. Although the prevalence of MetS is high in patients with first-episode schizophrenia (FES), little is still known about the level of and possible barriers for physical activity in FES. AIM: The purpose of the study was to compare physical activity in patients with FES with healthy controls; to investigate changes in physical activity over 1 year of follow-up; and to explore the correlations of physical activity and anomalous bodily experiences reported by patients with FES. METHODS: Both physical activity and aerobic fitness were measured. Anomalous bodily experiences were measured by selected items from the Examination of Anomalous Self-Experience and The Body Awareness Scale. Psychopathological data comprising negative and positive symptoms and data on psychotropic medication were obtained from medical records of all patients. RESULTS: Physical activity and aerobic fitness was significantly lower in patients with FES compared with healthy controls (p < 0.001). Over 1 year of follow-up patients had lower physical activity and aerobic fitness. Patients with more severe anomalous bodily experiences had significantly lower physical activity compared with patients with fewer such experiences (p = 0.030). In linear regression analyses only negative symptoms were significantly correlated with low physical activity (ß = -0.88; 95% confidence interval = -1.48 to -0.29; p < 0.001). CONCLUSION: Physical activity and aerobic fitness is low in patients with FES. Both anomalous bodily experiences and negative symptoms are significantly correlated with low physical activity.

Low levels of physical activity in patients with severe mental illness.

BACKGROUND: Physical inactivity is an independent risk factor for cardiovascular diseases and Type 2 diabetes, both being highly prevalent in patients with severe mental illness. Though physical activity has become an important issue in psychiatric treatment and rehabilitation in the past decade, systematic evaluations of physical activity level in psychiatric populations could be more disseminated. AIM: The primary aim of the study was to investigate the physical activity level of psychiatric patients in comparison with healthy controls. METHODS: Patients with severe mental illness (n =47) and a group of healthy controls (n =28) matched on sex and age reported their physical activity level using the Physical Activity Scale (PAS). PAS was administered as an interview in relation to patients and as a questionnaire in relation to healthy controls. RESULTS: Patients had statistically significant lower levels of physical activity compared with healthy controls (P <0.0001) and the level of physical activity among patients was hazardously low. CONCLUSION: The study confirmed previous studies and clinical experience that patients with severe mental illness are physically inactive and emphasize the importance of physical activity in psychiatric treatment and rehabilitation. The PAS is an applicable and relevant method for evaluating physical activity levels in psychiatric patients.

Comparing the Movement Assessment Battery for Children with the Bruininks-Oseretsky Test of Motor Proficiency in adolescents with and without schizophrenia.

BACKGROUND: As motor impairments have implications for health and functioning, they need to be addressed early, not only in childhood but also in adolescence, the period in which mental disorders as schizophrenia, typically develops. Further, the possible prognostic value of motor impairments in schizophrenia highlights the importance. The Bruininks-Oseretsky Test of Motor Proficiency (BOT-2) and the Movement Assessment Battery for Children (MABC-2) assess adolescent motor performance. However, MABC-2 is not valid past age 16 and has no sex-norms. Further, while the concurrent validity between the tests and their ability to distinguish between clinical and non-clinical groups has been established in children, however they have not been established in adolescence. PURPOSE: To compare the ability of MABC-2 and BOT-2 to distinguish between adolescents with and without schizophrenia, to examine the concurrent validity between tests, to examine the agreement between tests in classifying adolescents "at risk" or scoring "below average" and to examine the influence of age and sex on MABC-2. METHOD: Motor performance assessed by BOT-2 and MABC-2 was compared in 25 adolescents with schizophrenia (14-18) and age- and sex-matched controls using t-test, Cohen's D and false discovery rate's q-value. The associations between tests were assessed using Pearson's correlation and Lin's concordance correlation coefficient. The Kappa coefficient was used to assess the agreement between tests in classifying "risk/below average" and linear regression was adopted to assess the influence of age/sex on MABC-2. RESULTS: MABC-2 and BOT-2 significantly distinguished adolescents with schizophrenia from controls with large effect size. A strong association (p > 0.001) was found between the tests. The tests revealed moderate agreement in identifying "risk" or scoring "below average". Only sex influenced MABC-2 scores. CONCLUSION: MABC-2 and BOT-2 are both useful for assessing motor performance and distinguishing between adolescents with and without schizophrenia, although BOT-2 provides a more detailed picture of the challenges in adolescent with schizophrenia.

Motor function in early onset schizophrenia-A 2-year follow-up study.

AIM: Motor symptoms primarily assessed by clinical rating are documented across the schizophrenia spectrum, but no studies have examined the longitudinal course of these symptoms in adolescents using tests that control for the natural maturational process. The aim is therefore to compare fine and gross motor function using age-adjusted tests in adolescents with schizophrenia and controls across a 2-year period, and examine if clinical correlates contribute to changes in motor function in adolescents with schizophrenia. METHOD: Motor function assessed by two age-adjusted tests was compared in 25 adolescents with schizophrenia and age- and sex-matched controls over a 2-year period using t-tests, Cohen's D and χ2 tests. Linear mixed models with a random intercept at patient level were used to assess changes between baseline and follow-up. The latter approach was adopted to assess the association between changes and potential predictors as age, sex, complications during labour/delivery, childhood motor function, symptoms severity, executive function and antipsychotics. RESULT: All measures of motor function but one significantly differentiated adolescents with schizophrenia from controls with large effect sizes at 2-year follow-up. The overall scores did not change during follow-up, whereas two resembling motor areas of the tests significantly improved in adolescents with schizophrenia. The severity of schizophrenia, sex and IQ revealed association with the changes. CONCLUSION: The finding of both stability and improvements from diagnosis to follow-up in adolescents with schizophrenia and the differences between adolescents with and without schizophrenia argue in favour of the neurodevelopment hypothesis and highlights the need for assessing motor function.

Motor impairments in early onset schizophrenia.

AIM: Motor impairments are frequent both at and before diagnosis. In childhood, impairments in general fine and gross motor function are among others identified using test batteries, and while elements of coordination are assessed in onset schizophrenia, the assessment of general motor functions is absent. Thus, we aimed to assess general motor function including childhood motor function in adolescents with schizophrenia in comparison with healthy controls and examine clinical correlates to general motor function. METHOD: General fine and gross motor function was assessed using two standardized age-normed test batteries and a questionnaire in 25 adolescents with schizophrenia compared with age and gender-matched controls using t-test and χ2 -test. Stepwise linear regression assessed potential developmental predictors on motor function including complications during childbirth, reported childhood motor function, executive function including false discovery rate q-values. Associations with schizophrenia symptom severity, executive function, cognitive function were assessed using Pearson's correlation and the impact of antipsychotic medication using t-test. RESULT: All measures of motor function but one significantly differentiated adolescents with schizophrenia from healthy controls. The presence of schizophrenia (ß =4.41, ß = 10.96), explained the main part of the variance however, childhood motor function (ß = .08) also added significantly to motor function. Executive function (ß = -.45) was important for childhood motor function. Severity of schizophrenia was associated with strength (p < .0011) and manual coordination (p = .0295), and receiving antipsychotics affected manual dexterity (p = .0378). CONCLUSION: The documentation of significant differences in general motor function in early onset schizophrenia compared with healthy controls highlights the need for general motor assessments and potential interventions.

Enhanced Mental Health with Virtual Reality Mental Hygiene by a Veteran Suffering from PTSD.

This paper describes the application and feasibility of the use of Virtual Reality Mental Hygiene (VRMH) as a mean to reduce anxiety and stress in a Danish veteran suffering from posttraumatic stress disorder (PTSD) and enduring personality change after a catastrophic experience. The results from this case study provide preliminary evidence that VRMH can be used as a mean to reduce arousal in patients with severe PTSD.

Non-pharmacological interventions for preventing weight gain in patients with first episode schizophrenia or bipolar disorder: A systematic review.

Weight gain is a side effect of antipsychotic medication and highly prevalent in people with schizophrenia or bipolar disorder, increasing their overall cardio-metabolic risk. We conducted a systematic review on non-pharmacological interventions for preventing/reducing weight gain or increase in waist-circumference in young, newly diagnosed patients with schizophrenia or bipolar disorder. We searched major electronic databases from inception to 04/2019 on RCTs, pre- and post-test studies, and non-randomized controlled clinical trials. From a potential of 2963 hits, eight studies met the inclusion criteria (n = 438, mean age of 18.8 (13-45) years). The interventions comprised supervised and individually adjusted aerobic exercise activities (5 studies), individual lifestyle counselling vs. control condition (2 RCTs), and dietetic counselling and practical training of cooking and shopping (1 study). Physical activity and practical dietetic interventions seem to be more efficient than lifestyle counselling. However, the results shall be taken with caution due to the non-randomized designs and other methodologically deficits in the majority of the included studies.

Bodily symptoms in patients with post traumatic stress disorder: A comparative study of traumatized refugees, Danish war veterans, and healthy controls.

BACKGROUND: Post traumatic stress disorder (PTSD) is associated with increased general health symptoms and patients suffer from numerous bodily complaints such as increased pain, increased muscular tension, and restricted breathing. METHODS AND MATERIAL: This study applied the Body Awareness Movement Quality and Experience scale (BAS MQ-E) in assessing and comparing bodily symptoms, including movement function, in traumatized refugees (N = 14) and Danish war veterans with PTSD (N = 19) and healthy controls (N = 20). RESULTS: Patients with PTSD had significantly poorer stability, balance, flexibility and coordination in movement, had more muscular tension, more complaints of pain, more restricted breathing, and more limitation in function of daily life than healthy controls. CONCLUSION: The BAS MQ-E was found to be an applicable and useful measure of bodily symptoms in patients with PTSD. Further research may add to the validity of BAS MQ-E and might be considered in future studies evaluating the efficacy of physiotherapy for patients with PTSD.

International Organization of Physical Therapy in Mental Health consensus on physical activity within multidisciplinary rehabilitation programmes for minimising cardio-metabolic risk in patients with schizophrenia.

PURPOSE: The excess cardiovascular morbidity associated with schizophrenia is attributed to an interplay between behavioural (physical inactivity, unhealthy diet, substance abuse), genetic and illness related factors, as well as the effects of antipsychotic treatment. Patients have limited access to physical healthcare with less opportunity for cardiovascular risk prevention and treatment programmes than the non-psychiatric population. The aim of this paper is to improve physical activity (PA) within rehabilitation programmes for people with schizophrenia. METHOD: The development process consisted of: a) systematic literature review on PA in schizophrenia in eight databases up to May 2010; b) review on existing national and international guidelines; c) consensus meetings, and d) formulation of the final consensus document. RESULTS: There is insufficient evidence for the relative contribution of PA reducing cardio-metabolic risks in people with schizophrenia. Demographical, biological, psychological, cognitive-behavioural, emotional, social and environmental barriers for PA could be identified. CONCLUSIONS: Although PA outcomes on cardio-metabolic parameters are still unknown, the benefits of physical activity as part of a larger lifestyle programme are sufficient for the recommendation that persons with schizophrenia follow the 2008 U.S. Department of Health and Human Services PA Guidelines with specific adaptations based on disease and treatment-related adverse effects.

[Metabolic syndrome in schizophrenia]. / Metabolisk syndrom ved skizofreni.

The metabolic syndrome (MetS) is a serious risk factor for cardiovascular disease and type 2 diabetes, both of which are highly prevalent in patients with schizophrenia. Unhealthy lifestyle and antipsychotic medication are well known causes of MetS. Pharmacological as well as non-pharmacological interventions, including cognitive behavioural therapy, physical exercise and diet, seem to be effective in reducing MetS. Systematic screening and early intervention of MetS in patients with schizophrenia would be beneficial in reducing the risk of somatic disease and early death.