Schizophrenia and Cognition: Exercise Can Improve Speech, Attention, and Processing Speed

What’s happening – With Spring officially here, many are headed outside for exercise and a breath of fresh air. The benefits of physical activity on mental health are well known, but some researchers are looking more specifically at the relationship of exercise and cognition. Huang et al completed an RCT to study the effects of aerobic walking (AW) and exercise intensity on cognition in people with schizophrenia. Participants were placed in a treatment-as-usual group (TAU, n=34) or a TAU with AW group (TAW, n=33) for 12 weeks. Those in the TAW group wore a Fitbit monitoring device and were placed into high- (n=11) or low-intensity (n=22) groups based on heart rate. The average walking time was 129 minutes/week. The research team found some improvement in verbal fluency in the TAW group and found a significant group effect on attention and processing speed between the high- and low-intensity walking groups.

The details – Read the full study by Huang et al in the Journal of Psychiatric Research.

The perspectives

  • Aerobic exercise intervention was associated with significant decrease in BMI, blood pressure, and disease severity, as well as improvement in daily life activities in people with schizophrenia in a paper published in Frontiers in Psychiatry.
  • A separate 12-week pilot program applied moderate-intensity bench-step exercise training program in people with schizophrenia and found gains in cardiopulmonary fitness and mood state but no change in attention.
  • A review article examines the different ways that both physical training (eg, aerobic activity, strength training) and motor activities (eg, flexibility, balance, coordination) can improve cognition in older adults.
  • Stern et al studied aerobic exercise for cognition in adults age 20-67 years and found that the effects on executive function increased with age. Improvements to brain health were measured in adults as young as 20.
  • A recent paper by Aguirre-Loaiza et al argues that physical activity must be promoted by the scientific community and government to combat the effects of the pandemic, namely, a rise in obesity and psychopathology cases.

The conversation

  • @GamianE (GAMIAN-Europe, an advocacy group for mental health patients) tweeted in support of last week’s Brain Awareness Week: “Let’s raise awareness of the importance of understanding the #brain to foster better #mentalhealth.” They shared an infographic that outlines how sleep, exercise, and nutrition can create a healthier brain.
  • @cha_murdoch (Centre for Healthy Ageing at Australia’s Murdoch University) tweeted “Great review by our Murdoch-CHA PhD candidate Shaun Markovic on the effects of modifiable lifestyle factors on cognition following traumatic brain injury!” and linked to the article in Ageing Research Reviews.
  • @CdnDownSyndrome (the Canadian Down Syndrome Society) tweeted, “This World Down Syndrome Day, we’re launching Mindsets, a first-of-its-kind 8-week research study to examine the link between exercise and cognition. Learn how you can participate here,” linking to information about the planned study.

In practice – Certain mental health apps include guided exercise programs, allowing clinicians to monitor progress. Plus, the latest on first-line approaches to managing schizophrenia and how to work with schizophrenia patients using teletherapy.

SUDs and Hospitalization: The COVID Pandemic Toll

What’s happening – Hospitalized individuals with a substance use disorder (SUD) faced numerous hardships and uncertainties in the early days of the pandemic, according to a recent qualitative study from Oregon Health & Science University. Using interviews conducted in April and May 2020, researchers identified four main challenges experienced by a small group of patients: insecurity for basics needs (eg, food, housing, public bathrooms) and social services; utilizing the hospital as a safety net when in-person or online services could not be accessed; isolation in the hospital due to COVID precautions; and finding housing after hospital discharge.

The details – Read the full study by King et al in PLOS ONE and see our in-depth Q&A with the authors in the below Psy-Q.

The perspectives

  • Courtney Gallo Hunter of Shatterproof, a nonprofit supporting those with addiction, discusses the “epidemic within the pandemic” of SUD and COVID-19, including the barriers to care and stigma faced by this population.
  • An opinion article in Philly Voice by ER physician Kevin M. Baumlin, MD, FACEP, discusses the challenges of dealing with the pandemic in the middle of the opioid use disorder crisis, and the harm that comes from the stigma within the medical community as well as without.
  • In New England, resources to help improve the lives of those with SUD include the opening of a new center in Maine that houses three organizations that help people with SUD, and New Hampshire announced the allocation of $9.4 million in grants for mental health and SUD.

Why it’s complicated – People experiencing homelessness or unstable housing disproportionally have chronic health conditions and SUDs; two recent studies addressed strategies to help during the pandemic.

  • Researchers in San Francisco set up five hotels to provide mental and behavioral health services to people experiencing homelessness with mild or moderate COVID-19 diagnoses as they isolated and quarantined, which freed up hospital capacity and resources. The study period ran from March to May 2020, served 1009 patients, and had a retention rate of 81% with an average stay of 13 days.
  • An invited commentary in the same issue of JAMA Open Network argues that “housing is an essential part of healthcare.”
  • A similar program in Boston set up a COVID-19 Recuperation Unit next to a large hospital, Boston Medical Center, which provided medical care and substance use treatment while patients remained in isolation and quarantine and unable to return to a safe home. The authors concluded that this approach could limit the spread of COVID-19 to homeless individuals and help hospitals during COVID-19 surges.

The conversation

  • @PADrugAlcohol (The Pennsylvania Department of Drug & Alcohol Programs) tweeted “COVID-19 has created extra challenges for individuals with a substance use disorder and individuals in recovery,” and linked to an Addiction Policy Forum article about attitudes toward the COVID-19 vaccine among people with SUD.
  • @NAADACorg (the association for addiction professionals) tweeted, “Even though the need for mental health and substance use disorder providers has skyrocketed during the pandemic, addiction professionals are struggling to receive COVID-19 testing supplies, and are not included on the priority list for vaccinations,” linking to this STAT article.
  • @SCPdiv12 (Society of Clinical Psychology/American Psychological Association’s Division 12) tweeted “Check out the nearly $4 billion in new funding for mental health and substance use disorder initiatives included in the American Rescue Plan Act!” and linked to the APA’s article detailing the funding gains.

In practice – See how a personal catastrophe led psychiatrist Michael D. McGee to take on homelessness and mental health. Plus, a look at which mental health programs will be funded by Biden’s American Rescue Plan.

Psy-Q: This Week's Challenge

How did community and hospital policy changes early in the pandemic affect hospitalized patients with SUD? Caroline King, PhD, MPH, and Honora Englander, MD, answer.

Get the Answer

Disney Philips Animation Pilot Aims to Reduce Children’s Anxiety

What’s happening – The Avengers’ next mission will be to help with scientific research alongside Moana, Yoda, Mickey, and others in a collaboration with the health technology company, Royal Philips. A pilot program is set to begin this summer in six European hospitals to test the effects of custom Disney animation while children undergo MRI testing. The goal, says Philips, is to reduce children’s anxiety and feelings of claustrophobia, improve the ability of staff to complete the scans, and reduce rescans. The original Disney stories will be implemented in the Philips Ambient Experience, which is designed to make young patients feel more relaxed and in control by allowing them to personalize the lighting, video, and sounds during their MRI.

The details – Read about the pilot study in the Philips press release.

Why it’s noteworthy – Researchers have investigated all types of interventions to reduce children’s pain, anxiety, stress, and fear before and during medical procedures, including virtual reality (VR). Could a personalized medicine approach be the ticket? Some suggest digital interventions may help the effectiveness of long-term psychological treatment as well.

  • An RCT found that three methods of reducing anxiety about venipuncture in children were effective: direction cards, VR, and the Buzzy device, which delivers cold and vibration to numb the injection site.
  • Researchers found that VR as a distractor and anxiety reducer for children during cast removal was both effective and easy to set up. Additionally, they recommended the use of a short VR movie rather than a game for younger patients due to the time it took some younger children to understand the controls of the game compared to older patients.
  • A planned study will compare distraction-based VR, passive control 360 video, and guided relaxation-based VR, a novel therapeutic mechanism that uses mind–body relaxation techniques to reduce pain. Researchers plan to measure postoperative pain intensity, pain unpleasantness, anxiety, as well as opioid and benzodiazepine consumption in children who experienced Nuss repair of pectus excavatum.
  • Halldorsson et al provided a systematic review that looked at VR and digital applied gaming interventions for the treatment of mental health disorders such as anxiety, depression, and phobias. The authors suggested that digital interventions may help increase access and effectiveness of psychological treatments.

The conversation

  • @angelaidcares (Angel Aid, an organization that helps families living with rare diseases) tweeted “We created a no-cost Trauma-Less Needle Pokes Wellness Kit, containing pain management tools, distraction cards, and self-care aids to help children complete their needle pokes with less pain and anxiety.” The kit includes the Buzzy device.
  • @liz_gordon (Dr. Elizabeth Gordon, neuroscience PhD) tweeted “Some feel-good news to help reduce the fear and anxiety children feel during their clinical scans!!” and linked to the Philips/Disney announcement.
  • @AmericanCancer (the American Cancer Society) tweeted, “We are so proud of our Innovation and Cancer Control teams for designing the Pediatrics Virtual Reality program with @ChildrensAtl, a program that offers VR headsets to children going through treatment in order to help reduce pain & anxiety.” An article describes how the VR games help with pain and anxiety of chemotherapy treatments when the program began nearly two years ago.

In practice – More on managing anxiety and mental health in children. How to use mental health apps as treatment adjuncts.

Last Updated: Apr 20, 2021