精神分裂症患者運動、睡眠與認知功能之探討

The exercise,sleep and cognitive function of Schizophrenia

吳沁縈(Wu Chin Ying)

指導教授 ： 葉玲玲 ； 李信達

亞洲大學/健康學院/長期照護研究所在職專班/碩士(2011年)

摘要

研究背景: 認知功能受損是造成精神分裂症患者長期失能的主要原因之一，而在動物實驗中，運動可以保護神經元避免受損、活化神經細胞、促進神經增生及改善學習能力等表現，但運動對於精神分裂症患者的認知功能影響則還待釐清。另外，睡眠紊亂是精神分裂症患者常見的臨床症狀，研究顯示與正性症狀、負性症狀、疾病預後及認知功能缺失有顯著相關性；而患者長期服用抗精神病藥物，可能產生的肥胖負作用，間接造成的睡眠呼吸障礙(Sleep-Disordered Breathing)則尚未有定論。
研究目的: 此研究有二目的--第一部份探討精神分裂症之精神症狀嚴重度與睡眠狀態、認知功能、血液生化指標及體適能的相關性；第二部分欲了解運動是否可改善精神分裂症患者的精神症狀、體適能狀況及認知功能。
研究方法: 第一部分--以精神症狀量表(PANSS)之正性症狀、負性症狀、一般病理三項的分數高低，做為症狀嚴重度分組依據，各自分析與體適能、生化指標、睡眠狀態、認知功能的相關性；第二部分--以20週運動(快走)介入的有無，分析有氧運動對於精神症狀、體適能、血液生化指標與認知功能的影響。
研究結果:第一部分-- 體適能:正性症狀較嚴重者，體重較重、頸圍較大；ㄧ般精神病理較明顯者，體重較重、腰圍較大、腰臀比較高。認知功能:負性症狀較嚴重者，其圖形區辨(視覺學習)能力較高。血液生化檢查:負性症狀較嚴重者，T4濃度較高。睡眠生理檢查:正性症狀較嚴重者，其總睡眠時數較長、睡眠效率較低、stage2及stage3比例較低、緩波睡眠(熟睡期)比例較低、平均血中含氧量比例較低，ㄧ般精神病理較明顯者，其stage2及stage3比例較低。第二部分--相依樣本T檢定分析發現，運動組的臀圍減少，心肺適能增加；整體精神症狀量表分數與負性症狀分數減少；認知功能的語文流暢度增加與立即聽覺學習能力進步；生化檢驗項目中三酸甘油脂(triglyceride)指數下降；以共變數分析(ANCOVA)，則發現運動介入能有效減少臀圍及體重，且認知功能中視覺學習的能力增加。
討論:第一部分--正性症狀較嚴重者，睡眠效率明顯較低，緩波睡眠(stage3+4)較短，顯示睡眠紊亂可能是精神分裂症的前驅指標之一；第二部分--運動介入對於視覺學習能力有顯著影響，即視覺化的學習記憶可能因運動介入而改善，且建議運動可作為輔助療法改善精神分裂症的負性症狀，但此研究樣本數較少，仍需進一步研究佐證結果

關鍵字

運動 ； 體適能 ； 精神分裂症 ； 多項式睡眠檢查 ； 認知功能

並列摘要

Objective: this study has two purposes--first: we try to find out the relationships of psychotic symptoms, polysomnography, cognitive functions and physical fitness of patients with schizophrenia; second: we intent to investigate the effect of exercise program on psychotic symptoms, cognitive functions, and physical fitness of patients with schizophrenia.
Method: Part I- using the average score of positive symptoms, negative symptoms, general pathology of PANSS as the basis of grouping, analysis the relevance between severity of psychotic symptoms, physical fitness, polysomnography and cognitive functions; part II-total trial duration is 20 weeks. Intervention is fast-walking(MET=4) for 30 minutes, warm-up and cool-down each for 5 minutes everyday, five days a week. Measurement is taken before trial and the end of trial. The measurements include physical fitness, PANSS and cognitive function.
Results: Part I -Physical fitness: patients with more severe positive symptoms have heavier weight, larger neck circumference; patients with more severity of psychopathology have heavier weight, larger waist circumference and higher waist-hip ratio. Cognitive functions: patients with more severe negative symptoms, the graphics distinguishing (visual learning) ability is better. Serum biochemistry: patients with more severe negative symptoms, thyroxine level is higher. Polysomnography: patients with more severe positive symptoms have longer total sleep time but lower sleep efficiency, lower SpO2 level, and the proportion of stage2, stage3 and slow wave sleep is relatively lower; Part II - through paired T test, revealed that the exercise group reduce the hip circumference, improve cardiovascular fitness; decrease triglyceride level; decrease the total score of PANSS; language fluency and immediate learning in auditory progress increased; through the analysis of covariance, found that exercise intervention can reduce body weight and hip circumference, and improve only in the visual learning ability of cognitive function.
Discussion: Part I-- patients with more severe positive symptoms have significantly lower sleep efficiency, shorter slow wave sleep (stage3 +4), it propose that sleep disturbance may be a trait marker of schizophrenia; Part II-- exercise intervention has a significant impact in visual learning of patient with schizophrenia in this study; and suggest that exercise can be used as adjuvant therapy for negative symptoms of schizophrenia, but this study relatively got small sample size, further research is needed to show more evidences.

並列關鍵字

exercise ； physical fitness ； polysomnography ； cognitive functions ； Schizophrenia

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