Exercise and Serious Mental Illness

Question 1

What is serious mental illness (SMI)?

Answer 1

• group of disorders: schizophrenia, bipolar disorder, and major depressive disorder
• significantly impact functioning and contribute a distortion in reality
• 40-100% increased risk of developing cardiometabolic diseases

Question 2

schizophrenia

Answer 2

disturbance for greater than 6 months, 2 major symptoms for greater than 1 month
- delusions
- hallucinations
- social withdrawal
- flat affect
- anhedonia
- cognitive impairment

Question 3

What are some positive symptoms of schizophrenia? Add something to the normal experience?

Answer 3

• delusions
• hallucinations

Question 4

delusions

Answer 4

additional beliefs about one’s culture or normal life

Question 5

hallucinations

Answer 5

perceptual disturbances in the absence of external stimuli; seeing things that aren’t there or feeling things

Question 6

What are some negative symptoms of schizophrenia?

Answer 6

• social withdrawal
• flat affect
• anhedonia
• diminished motivation

Question 7

flat affect

Answer 7

no emotions expressed with the face

Question 8

What are some cognitive symptoms of schizophrenia?

Answer 8

attention, working memory, executive function, and social cognition (understanding social environments)

Question 9

bipolar disorder

Answer 9

alternating periods of depression and mania

Question 10

mania

Answer 10

elevated, expansive, or irritable mood that lasts for at least one week and is present for most of the day or nearly every day

Question 11

What are some symptoms that could be present during a manic episode?

Answer 11

3 or more must be present:
- inflated self-esteem
- decreased need for sleep
- increased talkativeness
- racing thoughts
- distracted easily
- increase in goal-directed activity or psychomotor agitation
- engaging in activities that hold the potential for painful consequences

Question 12

bipolar I

Answer 12

highest and lowest swings

Question 13

cyclothymia

Answer 13

moderate high & low, but still a concern

Question 14

bipolar II

Answer 14

mania doesn’t get as high, but depression still hits really low

Question 15

major depressive disorder

Answer 15

depressed mood/anhedonia + secondary symptoms; 5 total in more than 2 weeks

Question 16

What are some symptoms of MDD?

Answer 16

• changes in appetite
• sleep disturbances
• psychomotor retardation or agitation
• fatigue
• feelings of worthlessness or guilt
• poor concentration
• thoughts of suicide/death

Question 17

psychosis

Answer 17

symptoms that influence thoughts/perceptions of reality
- hallucinations (never knowing what is real or not)
- delusions (hard to convince the person otherwise)
- disordered thinking/cognition (think but can’t execute in a structured way)
- associated with schizophrenia

Question 18

What are some modifiable risk factors for SMI?

Answer 18

1. cigarette smoking (50% in SMI)
2. inactivity (withdrawal/isolation)
3. poor diet (meds make users hungry/not hungry)
4. sleep (most report sleep disturbances)

Question 19

What are some of the current treatments for SMIs?

Answer 19

1. medications (antidepressants/antipsychotics)
2. therapy
3. physical activity

Question 20

What are some side effects for medications of SMIs?

Answer 20

• cardiometabolic (80% of people on the antipsychotics experience significant weight gain)
• endocrine (sexual dysfunction/menstruation issues)
• neuromotor (muscle spasms/involuntary movements)

Question 21

What effect did physical activity have on schizophrenia?

Answer 21

• improves positive and negative systems
• impacts global cognition
• helps cardiometabolic health and fitness

Question 22

What effect did physical activity have on MDD?

Answer 22

exercise is as effective as other treatments; recommended as an adjunct w/ other treatments

Question 23

What effect did physical activity have on bipolar disorder?

Answer 23

• very little data on exercise with BD
• may reduce mood fluctuations/improve depression
• unclear effect on manic episodes (hard to predict because they are short & predictable)

Question 24

What are some barriers to PA and SMIs?

Answer 24

• physical (comorbidities/obesity & side effects/weight gain)
• mental (major symptoms: low fatigue, low sleep, etc.)
• social (low support; socially withdrawn can make this difficult)

Question 25

Is it safe for people to exercise with SMIs?

Answer 25

Yes! They respond to exercise & not at an increased risk of injury.

Question 26

What are some considerations with exercise for people with SMIs?

Answer 26

• fatigue
• social anxiety (especially with body changes)
• medication side-effects; particularly antipsychotics (drowsy & dry mouth)
• psychotic symptoms (gym/teams may not work well)

Question 27

Where can you find exercise professionals in SMI services?

Answer 27

• popular in Europe and Australia
• useful because professionals are trained in prescription and management of physical activity for health conditions