Does Physical Exercise Increase Brain-Derived Neurotrophic Factor in Major Depressive Disorder? A Meta-Analysis.

BACKGROUND: Major depressive disorder (MDD) is one of the most common disorders in the world, but is generally refractory to antidepressant treatment. However, physical exercise has been demonstrated to improve MDD symptoms, though the mechanism through which this is achieved is not clear. This systematic review and meta-analysis aimed to clarify whether physical exercise increased brain-derived neurotrophic factor (BDNF) in patients with MDD to either establish or rule out this effect as a possible mechanism. SUBJECTS AND METHODS: We searched five electronic databases (PubMed, PsycINFO, CHINAL, Cochran Library, and Japanese Central Review of Medicine) for interventional studies released prior to 24 October 2017, examining the effects of physical exercise on BDNF in patients with MDD that compared the experimental group with an MDD control group. Those studies meeting the inclusion criteria were subjected to a meta-analysis in which changes of BDNF from baseline to post-exercise were quantified, with a standard mean difference and random effect model. RESULTS: Five studies were eligible and included 199 participants. All articles included subjects with severe symptoms; three articles studied inpatient populations. All articles introduced aerobic exercise. We found no significant effect of physical exercise on BDNF levels (Z=0.32, p=0.75), and no heterogeneity (I2=0%). The risk of bias was moderate. CONCLUSIONS: We conclude that physical exercise does not significantly increase BDNF in patients with MDD. Thus, while increased BDNF has been shown to be beneficial in patients with MDD, physical exercise likely produces its benefits through a different mechanism. However, the small number of included articles and lack of multiple reviewers increase the risk of the result being a false negative.

Correlations between physical activity and neurocognitive domain functions in patients with schizophrenia: a cross-sectional study.

BACKGROUND: Neurocognitive dysfunction is a critical target symptom of schizophrenia treatment. A positive correlation between physical activity level and neurocognitive function has been reported in healthy individuals, but it is unclear whether such a correlation exists in patients with schizophrenia and whether the relationship is different according to inpatients or outpatients. This study aimed to examine the differences in the correlations between physical activity and multiple neurocognitive domains in inpatients and outpatients with schizophrenia and obtain suggestions for further study to facilitate this field. METHODS: Twenty-nine patients with schizophrenia were examined (16 inpatients and 13 outpatients, 56.0 ± 11.4 years of age). Current symptoms were assessed using the Positive and Negative Symptom Scale and neurocognitive functions using Cognitrax, which yields a composite neurocognitive index (NCI) and 11 domain scores. After testing, participants wore an HJA-750C accelerometer for one week to measure physical activity levels and durations. Partial correlation analyses were performed between exercise and cognitive parameters. RESULTS: In the outpatient group, higher physical activity was associated with faster Motor and Psychomotor Speeds in outpatients. However, higher physical activity was associated with lower overall NCI, Attention score, and Memory scores in inpatients. CONCLUSION: Although higher physical activity was associated with better neurocognitive functions of outpatients, in inpatients with non-remitted schizophrenia, higher physical activity was associated with worsening of several cognitive domains. In a future study examining the relationship between physical activity and neurocognitive function for facilitating this research field, separation between inpatients and outpatients are needed because the relationship is different between inpatients and outpatients.

Association between altered physical activity and neurocognitive function among people with schizophrenia: A minimum 6-months' follow-up study.

BACKGROUND: The long-term benefits of physical activity on neurocognitive function among patients with schizophrenia, specifically among inpatients, remain unclear. This preliminary study, with a minimum of 6-months' follow-up, examined alterations in physical activity and neurocognitive function in both inpatients and outpatients with schizophrenia. METHODS: Symptoms and neurocognitive function were assessed at 2 intervals using the Positive and Negative Symptom Scale and Cognitrax, respectively. After each testing period, participants wore an accelerometer for 1week to measure their levels and duration of physical activity. After the 6-months' follow-up (average duration, 235.9±36.2days), participants were divided into 2 groups based on either increased or decreased activity, as compared with baseline: increased-activity and decreased-activity groups. RESULTS: Of the 29 initially enrolled participants, 25 (mean age, 56.8±11.8years) completed the follow-up. Reaction times in the increased-activity group in daily activity (n=10) improved as compared with the decreased-activity group (n=15). Moreover, cognitive flexibility and executive function improved in the increased-activity group in steps (n=7) compared with the decreased-activity group (n=18). Finally, there was no association between the duration of moderate or vigorous exercise and neurocognitive function. CONCLUSIONS: Together, our results suggest that increased daily activity and walking, but not high intensity activity, are associated with improved neurocognitive function in patients with schizophrenia.

Self-compassion and related factors in severe mental illness: A scoping review.

PURPOSE: To clarify what is known and identify research gaps on the role of self-compassion (SC) and potential interventions for individuals with severe mental illness (SMI). DESIGN AND METHODS: We analyzed 24 studies of SC in schizophrenia spectrum disorder, bipolar disorder (BD), and major depressive disorder (MDD). FINDINGS: Mindfulness-based cognitive therapy (MBCT) was the most common intervention. Predicting depression by SC was common in MDD and BD; however, relationships between demographics/clinical variables and SC in BD and schizophrenia spectrum disorder remain unclear. PRACTICE IMPLICATIONS: MBCT increases SC in SMI. Data regarding predictors of SC are limited, especially in schizophrenia.

Effects of mild-intensity physical exercise on neurocognition in inpatients with schizophrenia: A pilot randomized controlled trial.

PURPOSE: To find suggestions for a future definitive randomized control trial and examine the effects of physical exercise on neurocognition in schizophrenia. DESIGN AND METHODS: Patients hospitalized with schizophrenia were randomly assigned to exercise (n = 5) or control (n = 17) groups. The experimental group performed an exercise regimen for 8 weeks. Following intervention, demographics, psychiatric symptoms, and neurocognitive functions were examined. FINDINGS: The patients in the control and exercise groups, 14 and 4, respectively, showed significant differences in hospitalization duration and negative symptoms. After controlling both, neurocognition improved in the exercise group compared with the control group. PRACTICE IMPLICATIONS: Mild-intensity physical exercise improves global neurocognition in schizophrenic inpatients and could lead to earlier release.

The effect of revised process recording on self-focus and self-compassion: A randomized controlled pilot study.

DESIGN AND METHODS: Thirty-five university nursing students in Japan participated in this randomized controlled trial. The revised process recording referred to self-compassion. Both the control and intervention groups completed the self-compassion scale (SCS) pre- and post-intervention. A repeated two-way analysis of variance examined the interaction effect of time × group on the SCS subscales. FINDINGS: A significant interaction effect was observed only for mindfulness; the score only increased in the intervention group. IMPLICATIONS FOR NURSING PRACTICE: The revised process recording might facilitate self-compassion, making it appropriate for nursing education.

Self-compassion and nursing competency among Japanese psychiatric nurses.

PURPOSE: This study examined the association of self-focus and self-compassion with nursing competency. DESIGN AND METHODS: Data of 433 psychiatric nurses comprising demographics, other-consciousness, self-compassion, self-focus, and nursing competency were analyzed using the Other-Consciousness Scale (OCS), Self-Compassion Scale (SCS), Japanese version of the Rumination-Reflection Questionnaire (RRQ), and Oriented Problem Solving Behavior (OPSN). FINDINGS: Higher internal aspect and lower fantastic aspect in OCS, higher reflection in RRQ, and lower SCS negative subscales predicted a higher OPSN score. The account rate of variance was 12.5%. PRACTICE IMPLICATIONS: Psychiatric nursing education should facilitate other-consciousness and reflection enhancement, and assuage uncompassionate attitude towards self.

Effects of self-compassion and self-focus on sleep disturbances among psychiatric nurses.

PURPOSE: Previous research has demonstrated that self-compassion improved sleep in geriatric samples. However, this may be due to an uncontrolled influence from self-focus, or interaction between self-compassion and self-focus. This study examines whether these findings apply to psychiatric nurses. DESIGN AND METHODS: Demographics, sleep disturbances, self-compassion, and self-focus of 404 psychiatric nurses were assessed. Hierarchical multiple regression was used to predict sleep disturbances. FINDINGS: Analyzes revealed that working more night shifts, less self-compassion, and rumination predicted worse sleep quality; however, the effect of self-compassion was not significant when controlling for self-focus. PRACTICE IMPLICATIONS: An association between sleep quality and self-compassion was observed, but not when controlling for self-focus. Rumination may have an impact on sleep, and reducing it may improve sleep in psychiatric nurses.

Comparison of factors predicting nursing skills between general and psychiatric nurses.

PURPOSE: I examined whether nursing skills are related to occupational stress, self-focus, and other-consciousness, and whether these relationships differ between general and psychiatric nurses. DESIGN AND METHODS: Two hundred seventy-one general and 317 psychiatric nurses completed a questionnaire assessing the aforementioned variables. Regression analysis was used to explore the predictors of nursing skills. FINDINGS: Internal and fantastic aspects (other-consciousness subscales) and psychological burden (occupational stress subscale) predicted nursing skills in both groups, while lower rumination and higher reflection scores predicted them only in psychiatric nurses. PRACTICE IMPLICATIONS: Nursing education should facilitate other-consciousness in general nurses, but self-focus in psychiatric nurses.

Neurocognitive Functions in Patients With Remitted and Nonremitted Schizophrenia: A Cross-Sectional Study.

PURPOSE: We aimed to clarify the neurocognitive features of outpatients with remitted and nonremitted schizophrenia. DESIGN AND METHODS: The neurocognitive functions of 22 remitted and 41 nonremitted outpatients with schizophrenia and age-matched healthy controls were compared, after controlling for demographic and psychiatric variables. FINDINGS: The spatial attention scores of both groups were lower than those of age-matched healthy controls. The processing speed and visual attention of remitted patients were better than those of nonremitted patients. PRACTICE IMPLICATIONS: Psychiatric nurses should place patients with nonremitted schizophrenia in environments that facilitate patient vigilance and limit the need for quick responses.

Neurocognitive differences between inpatients and outpatients with symptomatically nonremitted schizophrenia: A cross-sectional study.

PURPOSE: We aimed to examine whether neurocognition in individuals with nonremitted schizophrenia differed between inpatients and outpatients. DESIGN AND METHODS: We recruited 59 inpatients and 41 patients with nonremitted schizophrenia (assessed with the Andreason criteria), and neurocognitive functions were compared between both, controlling for demographics, psychiatric symptoms. FINDINGS: Outpatients with nonremitted schizophrenia performed better on tests of processing speed, visual attention, and working memory than did inpatients with nonremitted. PRACTICE IMPLICATIONS: To facilitate discharge for nonremitted inpatients, nursing could focus on processing speed, e.g., arranging the environment such that patients do not need quick responses.