Exercise therapy improves mental and physical health in schizophrenia: a randomised controlled trial.

OBJECTIVE: The objective of this multicenter randomised clinical trial was to examine the effect of exercise versus occupational therapy on mental and physical health in schizophrenia patients. METHOD: Sixty-three patients with schizophrenia were randomly assigned to 2 h of structured exercise (n = 31) or occupational therapy (n = 32) weekly for 6 months. Symptoms (Positive and Negative Syndrome Scale) and cardiovascular fitness levels (Wpeak and VO2peak ), as assessed with a cardiopulmonary exercise test, were the primary outcome measures. Secondary outcome measures were the Montgomery and Åsberg Depression Rating Scale, Camberwell Assessment of Needs, body mass index, body fat percentage, and metabolic syndrome (MetS). RESULTS: Intention-to-treat analyses showed exercise therapy had a trend-level effect on depressive symptoms (P = 0.07) and a significant effect on cardiovascular fitness, measured by Wpeak (P < 0.01), compared with occupational therapy. Per protocol analyses showed that exercise therapy reduced symptoms of schizophrenia (P = 0.001), depression (P = 0.012), need of care (P = 0.050), and increased cardiovascular fitness (P < 0.001) compared with occupational therapy. No effect for MetS (factors) was found except a trend reduction in triglycerides (P = 0.08). CONCLUSION: Exercise therapy, when performed once to twice a week, improved mental health and cardiovascular fitness and reduced need of care in patients with schizophrenia.

[Omega-3 fatty acids in the treatment of affective disorders: an overview of the literature]. / Omega-3-vetzuren bij de behandeling van stemmingsstoornissen. Een literatuuroverzicht.

BACKGROUND: More and more interest is being shown in fish oil because it contains omega-3 fatty acids which may have beneficial effects in a wide range of somatic and psychiatric disorders. AIM: To search the literature for evidence of the effectiveness of omega-3 fatty acids in affective disorders. METHOD: We studied the literature with the help of Pubmed (1966-March 2006) using the keywords 'depression', 'affective disorder', 'bipolar disorder', 'seasonal affective disorder', 'postpartum depression', 'puerperal depression', 'fatty acids', 'eicosapentaenoic acid', 'arachidonic acid', 'docosahexaenoic acid' and 'fish oil'. We obtained additional information from the bibliographic references attached to the articles concerned. RESULTS: Epidemiological studies and studies on fatty acid concentrations suggest a link between omega-3 fatty acids and affective disorders, although some of the results are contradictory. Some clinical investigations found that treatment with omega-3 fatty acids did have a positive effect, but the number of test subjects was very limited and some investigations even produced negative results. CONCLUSION: There is insufficient clinical evidence to prove conclusively that treatment with omega-3 fatty acids has a beneficial effect on affective disorders.

[Severe insuffiency of the aortic and tricuspidal valves associated with pergolide use]. / Ernstige aorta- en tricuspidalisklepinsufficiëntie door gebruik van pergolide.

A 58-year-old woman with Parkinson's disease was treated with high-dose pergolide for 10 years. After the addition of citalopram, a selective serotonin reuptake inhibitor, to treat an anxiety disorder, she developed cardiac decompensation that was most likely related to typical pergolide-related fibroproliferative abnormalities of the tricuspidal, aortic and mitral valves, without cardiomyopathy or coronary heart disease. The aortic and tricuspidal valves were replaced with prosthetics and pergolide was switched to ropinirol. At a control visit after one year, patient's heart function was stable. Pergolide is an ergot-derived dopamine agonist used in the treatment of Parkinson's disease and restless-legs syndrome. In 2002, it was first associated with heart-valve defects. Patients treated with pergolide should be monitored for clinical signs of heart-valve failure. If there is no evidence of heart-valve defects, then regular monitoring of cardiac function is indicated. In case of indications of heart-valve failure pergolide should be discontinued. In some cases the heart-valve abnormalitites are reversible.