中低強度運動對服用Clozapine之肥胖精神分裂症病患身體組成、血脂肪、精神症狀與憂鬱程度的影響

本研究要探討中低強度運動介入對服用Clozapine之肥胖慢性精神分裂症病患身體組成、血脂肪、精神症狀與憂鬱程度的相關影響。選取某精神專科教學醫院之病患，運動組、對照組各14人完成研究，運動組提供持續12週、每週3次、每次30~60分鐘的踏步機有氧運動。受試者中男性對身材滿意度高於女性，且符合代謝症候群診斷及憂鬱比率高於一般族群。運動組在介入後對身體質量指數、臀圍、腰圍、貝克憂鬱量表的憂鬱程度 (睡眠習慣改變、失去對性方面的興趣) 獲得顯著改善 (P＜0.05)。運動組與對照組相比能更有效的控制體重、身體質量指數、腰圍、體脂肪，並能改善憂鬱及簡短精神量表中的懷疑性(P≦0.05)，反之對血液生化數值並無顯著影響。在相關性分析中發現運動時間與腰臀比前後測差呈中度負相關、與高密度脂蛋白前後測差呈中度正相關；踏步次數與高密度脂蛋白前後測差呈中度正相關；正餐次數前後測差與血糖前後測差呈中度正相關；零食次數前後測差與低密度脂蛋白前後測差呈中度正相關。研究結果顯示12週的運動介入對身體組成、精神症狀、憂鬱程度有改善的效果，而運動量、運動時間和飲食量與身體組成、血液生化數值部分項目有中度相關，但運動介入對血液生化數值則無顯著影響。未來研究建議可增加樣本的多樣性、使用隨機分組，排除糖尿病、高血脂之個案以避免研究的誤差，並延長運動及後續追蹤時間以加強效果。

關鍵字

代謝症候群；貝克憂鬱量表；簡短精神症狀量表

並列摘要

Metabolic syndrome is a serious side effect of many atypical antipsychotic medications, yet successful strategies for significant weight loss are lacking. The purpose of this study was to assess the effects of exercise intervention on body composition, blood lipid profile, psychotic symptoms and depression status in schizophrenia with clozapine-therapy. Thirty-three schizophrenia patients with clozapine-therapy over 3 months in Yuli-hospital were included (Body Mass Index＞24 Kg/㎡, age＜60 yrs). They are divided into exercise and control group. Twenty-eight patients (14 in control and 14 in exercise group) finished the program. The exercise program is stepper training 30-60 minutes per section, 3 sections a week, total 12 weeks. Pre-test data reveal that male patient had better satisfaction on body figure than female; the prevalence of metabolic syndrome and depression disorder are higher than common population. After exercise intervention, exercise group had significant improvement on BMI, hip circumference, waist circumference or the items of sleeping behavior change and loss of sexual interesting in the Beck Depression Inventory-Second Edition. Compared with control group, the exercise group shows improvement on body weight, BMI, waist circumference, body fat, depression and suspiciousness in Brief Psychiatric Rating Scale. However the blood biochemical laboratory data did not had significant difference after training. The exercise duration reveals negative moderate correlation with Waist-Hip-Ratio change and positive moderate correlation with high density lipoprotein change. There is positive moderate correlation between the change of snacks times per day and low density lipoprotein change. According the result, we conclude that: The 12-week exercise training program contributes to the improvement of body composition, psychotic symptoms, and severity of depression. The amount and duration of exercise, diet amount reveal moderate correlation with body composition and some items of blood biochemical value. But the exercise intervention reveals no significant effect on blood biochemical value. For further study, we suggest increasing the sample’s diversity, random grouping, and excluding the patient with diabetes mellitus or hyperlipidemia history to lower the study bios. Additionally, we also suggest prolonging the exercise duration and follow-up period for more definitive result.