Cognitive deficits, obesity and disability in schizophrenia

Abstract

Despite 50 years of pharmacological and psychosocial interventions schizophrenia remains one of the leading causes of disability. The inability to function in everyday settings includes deficits in performance of social, occupational, and independent living activities. Schizophrenia is also a life-shortening illness, caused mainly by poor physical health and its complications. Dysfunctional lifestyles including sedentary behavior and lack of physical activity prevail, while treatment with adipogenic antipsychotic medication interacts with poor performance in screening, monitoring, and intervention that result in shortening of life expectancies by 25-30 years. Disability interferes with self-care and medical care, further worsening physical health to produce a vicious cycle of disability. Further, the neurobiological impact of obesity on brain functioning is substantial and relevant to schizophrenia. Decision making deficits that lead to choices resulting in obesity themselves have neurobiological determinants. Simultaneous treatment of cognitive deficits and related deficits in functional skills, ubiquitous determinants of everyday functioning in schizophrenia, and targeted interventions aimed at poor physical health, especially obesity and associated comorbidities, may lead to additive or even interactive gains in everyday functioning in patients with schizophrenia not previously realized with other interventions.

Physical performance and disability in schizophrenia

“…Domains of physical performance, neuromuscular and psychomotor deficits are all eminently modifiable in the general population, and as we have shown, in schizophrenia Strassnig et al, 2012. We believe that an accurately defined ‘holistic approach’ to disability reduction in schizophrenia, accounting for these domains, offers tremendous opportunity to move the disability burden in a positive direction.…”

High velocity circuit resistance training improves cognition, psychiatric symptoms and neuromuscular performance in overweight outpatients with severe mental illness

“…Regular physical exercise induces neurobiological, functional and structural brain changes associated with cognition (and by inference, functional capacity) and psychiatric symptoms in severe mental illness (Strassnig et al, 2012b). For example, one study in schizophrenia showed improvement in memory after only a short exercise period of 12 weeks, commensurate with relative increases in hippocampal volume of 12% and no change in a non-exercise group of patients (-1%) (Pajonk et al, 2009).…”

Cognition and disability in schizophrenia: cognition‐related skills deficits and decision‐making challenges add to morbidity

“…Rather, they likely suggest that cognitive impairments may contribute to the development of physical limitations. Obesity in schizophrenia is correlated with multiple impairments in nonsocial and social cognition. On the nonsocial side, decision‐making regarding dietary choices has been shown to be impaired.…”