Therapeutic Potential of Physical Exercise in Early Psychosis

Abstract

Which of the following represents a potential mechanism by which exercise may have neuroprotective effects?A. Reduced neuroinflammation. B. Upregulation of neurotrophic growth factors. C. Potentiation of remyelination. D. All of the above."Miguel" was 16 years old when he was referred to our clinic after social anxiety and depression evolved into signs of early psychosis. He had been in care for 2 years in private practice and was treated with various antidepressant medications and psychotherapy. During this time, he developed the perception that people strongly disliked him once they got to know him. He also heard his name called loudly from behind several times at school when no one was there. His community psychiatrist added risperidone, which suppressed the voices but led to lethargy and weight gain. A trial of aripiprazole was not effective, so he returned to taking risperidone along with escitalopram, gabapentin, and lorazepam. He was referred to our early psychosis program because of worsening symptoms and suicidal ideation despite this treatment. On initial evaluation by our team, Miguel described extreme sadness and self-hatred associated with suicidal ideation. He was preoccupied with disliking his appearance, discomfort in social interactions, and feeling "stupid" in class relative to his peers despite receiving good grades. He feared impulsively acting on suicidal ideation. He reported that his friends at school could see and hear his thoughts when he was at home. He was sure that comments friends made at school confirmed that they knew his private thoughts. He also reported being watched in his room by schoolmates who wanted to catch him doing something embarrassing, and he had to position himself away from the window to avoid being monitored. He described intrusive fears of close family members being harmed or killed. He had a family history of schizophrenia in a second-degree and a third-degree relative. Miguel met the threshold for "severe and psychotic" on the Structured continued See related features: Clinical Guidance (Table of Contents), CME course (p. 293), and AJP Audio (online)

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“…Effects on subjective energy are mixed and may represent differences in impact on physical and mental energy. The finding of improved mood, negative, and cognitive symptoms with limited impact on positive symptoms is consistent specifically with prior research among people with schizophrenia ( 26 ). Although the effects were subjective and modest, these findings were consistent across both semi-structured interviews and structured prospective ratings.…”

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“…While the mechanisms by which the different exercise interventions may have influenced the positive and negative symptoms of our patients extends beyond the scope of this study, several mechanisms have been proposed in the scientific literature. The most frequently cited are neuroprotective mechanisms such as decreased inflammation, increased neurogenesis and neuroplasticity via brain-derived neurotrophic factor, and remyelination of white matter tracts 48 .…”

The effects of aerobic, strength, or mixed exercise programs on schizophrenia symptomatology: a randomized clinical trial with a 10-month follow-up

“…While the mechanisms by which the different exercise interventions may have in uenced the positive and negative symptoms of our patients extends beyond the scope of this study, several mechanisms have been proposed in the scienti c literature. The most frequently cited are neuroprotective mechanisms such as decreased in ammation, increased neurogenesis and neuroplasticity via brain-derived neurotrophic factor, and remyelination of white matter tracts [41].…”