身心介面研究：肥胖患者的精神疾患共病與臨床特徵

Mind body interface: The Psychiatric Manifestations and Comorbidity in Obese Patients

辛明哲(Ming-Che Hsin)

指導教授 ： 王照元

高雄醫學大學/醫學院/醫學研究所碩士班/碩士(2019年)

摘要

背景：肥胖與精神障礙有著許多共同的風險因子與病理機制。然而目前在台灣目前並沒有完善的臨床研究，以方便研究人員系統性地探討肥胖在精神合併症的治療上的影響。本研究的目標是評估肥胖患者的精神疾病盛行率與嚴重性，並利用前瞻性的研究來探討精神病理學和肥胖治療方法、治療成效之間的關聯性。另一方面，使用動物模式來觀察減重手術對於肥胖動物的精神疾病的影響，以進一步對照臨床觀察所得結果。

實驗方法：由台灣地區門診蒐集249位肥胖受試者，系統性地收集受試者基本資料、病史以及評估其精神病理狀態。肥胖受試者在經過記錄與評估後，進行減重治療以達到減少過多體重的目的。此縱貫性的研究將評估其治療之前及治療後一個月、三個月、六個月的再追蹤結果，並且進行一系列的記錄與精神病理合併症的評估，用以探討在臨床治療前後體重改變、精神病理合併症以及生活品質的改變所造成的影響與結果。在動物模式方面，本研究使用高脂飼料建立肥胖動物模型，再經由誘導慢性壓力後檢測動物行為以確立動物的壓力行為，接著進行減重手術。在術後檢測動物行為模式來探討減重手術的療效對於精神疾病的影響。
結果：從受試者蒐集的資料顯示，肥胖患者中有高比率精神疾病（49.5％）；經過顯著性的體重改變後，精神病理合併症以及生活品質的改變出現正相關的影響，而從動物模式中同樣可以看到減重手術可以改善動物的壓力行為；本研究將提供精神障礙的盛行率以及其與肥胖嚴重程度關聯性的最佳可利用的資訊。除此之外，該縱貫性研究將更進一步地提供關於精神病理合併症之治療行為介入效果的前瞻性數據。

關鍵字

肥胖 ； 精神障礙 ； 憂鬱症 ； 縱貫性研究 ； 精神病理合併症 ； 減重手術

並列摘要

Abstract
Background: Obesity is one of the major challenges for public health in the 21st century. And the present studies indicate that obesity and psychiatric disorders share common risk factors and pathological mechanisms. It is believed that to eliminate these risk factors will be beneficial to the psychological condition and improve quality of life in obese in obese population. In Taiwan, there is no well-conducted clinical study to systematically investigate the role of obesity and its treatment on psychiatric comorbidity. The aim of this study is to evaluate the prevalence and severity of comorbid psychiatric disorder among obese patients. This study will also show the possible association between psychopathology and treatment in a prospective research.
Methods: In the planned longitudinal study, obese participants were enrolled from the out-patient departments in Taiwan to assess their demographic information and psychiatric conditions. A baseline and follow-up assessments at the one, three, and six months after bariatric surgery or medical intervention were performed to evaluate the outcomes of body mass index (BMI) changes, the severity of comorbid psychopathologies and quality of life. In the animal study, we establish diet-induced obese model, and then induced stress with unexpected chronic mild stress (UCMS). In order to confirm the relationship between obesity and psychiatric disorders, the animal behavior was determined before and after bariatric surgeries.
Results: The results show that psychiatric comorbidity and quality of life has a positive correlation with significant weight loss after bariatric surgery intervention. Furthermore, this study will provide the best available information on the prevalence of psychiatric disorders and their relationship to severity of obesity. The bariatric surgery also shows beneficial results to psychiatric disorders in animal model. In addition, this longitudinal study will further provide prospective data about the intervention effects on comorbid psychopathology in Taiwanese obese population.
Keywords: Obesity, psychiatric disorders, depression, longitudinal study, comorbid psychopathology, bariatric surger

並列關鍵字

Obesity ； psychiatric disorders ； depression ； longitudinal study ； comorbid psychopathology ； bariatric surgery

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