運動對於早期精神病是有效的介入方式?


  【24drs.com】運動似乎可以預測首次發作精神病(FEP)患者的功能,這個發現認為運動可以作為幫助此類患者改善結果的早期介入方式。
  
  香港大學進行的一篇大型研究發現,FEP病患的運動程度可顯著預測6個月後的功能結果。Edwin H. M. Lee醫師等研究者寫道,6個月時,運動力較差的病患,其功能結果比有活動力的病患差。
  
  這篇研究登載於11月的Schizophrenia Research期刊。
  
  研究者指出,越來越多人探討運動對於FEP患者心理和生理健康的影響;對一般人而言,不運動及生理疾病引起的死亡與失能率較高有關,也與認知功能不佳及整體認知衰退風險增加有關。
  
  研究認為不運動所累積的影響加上使用抗精神病藥物,使精神分裂症患者的死亡率風險進一步增加。
  
  研究者指出,探討運動和功能之關係的精神分裂症研究大多數是在有慢性疾病的病患進行。
  
  這次的研究檢視年紀25-55歲的283名FEP患者的運動和功能盛行率,這些病患招募自一項成年發作精神病的早期介入服務;研究開始時評估他們的運動程度、社會人口統計學資料與臨床特徵。
  
  使用國際運動問卷(IPAQ)評估運動情況,這個問卷可以測量過去7天內,花在走路的時間以及運動的強度(低、中、高);如果病患的評分為高或中度,則被視為有運動,評分為低度則視為不運動。
  
  使用發病前適應量表(PAS)評估發病前功能,使用正向症狀評估量表(SAPS )和負向症狀評估量表(SANS)評估開始時的正向和負向症狀;在6個月時再度評估這些研究對象。
  
  6個月時,使用角色功能量表(RFS)評估功能,這個量表可測量工作領域,獨立生活/自理,直接的社會網絡關係,以及擴展的社會網絡關係。
  
  研究結果顯示,96名(33.9%)患者屬於不運動,187名(66.1%)屬於有運動。研究者指出,這兩組在臨床或人口統計學特徵上並無顯著差異。
  
  6個月時,研究者發現,不運動組病患的功能比運動組患者差(RFS總分: 20.6 ± 3.9 vs 21.8 ± 3.4;t = -2.727;P = .007)。
  
  除了運動狀態,6個月時功能的其他顯著預測因子,包括在研究開始時有比較多的正向和負向症狀以及較低的家庭收入。
  
  研究結果支持「運動對於功能有調節角色」之假設。
  
  作者們的假設是,運動可以藉由改善認知、症狀和生理健康而獲得比較好的功能;這些因素最終都會影響運動,對於精神病之功能改善的良性循環扮演重要角色 。
  
  研究者報告指出,他們正計劃一項隨機控制試驗,探討不同類型運動對於FEP患者的影響。
  
  研究者結論指出,運動是一種簡單、不貴且非侵入性的介入方式,大力呼籲將運動整合到心智健康照護體系,特別是精神病早期介入的關鍵時期。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=7027&x_classno=0&x_chkdelpoint=Y
  
  

Exercise an Effective Intervention for Early Psychosis?

By Caroline Cassels
Medscape Medical News

Physical activity appears to predict functioning in patients with first-episode psychosis (FEP), a finding that suggests that as an early intervention, exercise may help improve outcomes in this patient population.

A large study conducted by investigators at the University of Hong Kong in China found that physical activity levels in FEP patients significantly predicted 6-month functional outcomes.

"At 6 months, physically inactive patients had poorer functioning than active patients," the investigators, led by Edwin H. M. Lee, MD, write.

The study is published in the November issue of Schizophrenia Research.

High-risk Population

The investigators note that there is growing interest in studying the impact of physical activity on psychological and physical well-being in patients with FEP.

In the general population, physical inactivity is associated with high rates of death and disability due to physical disease; it is also associated with poorer cognitive functioning and an increased risk for global cognitive decline.

The investigators point out that research suggests that the cumulative effect of physical inactivity and antipsychotic use can further boost mortality risk in patients with schizophrenia.

Most of the research in schizophrenia examining the relationship between physical activity and functioning has been conducted in patients with chronic disease, the researchers note.

In the current study, the investigators examined the prevalence of physical activity and functioning in 283 FEP patients aged 25 to 55 years recruited from an early-intervention service for adult-onset psychosis.

Physical activity level, sociodemographics, and clinical characteristics were assessed at study entry.

Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ), a tool that measures the amount of time spent walking as well as the intensity of physical activity ─ low, moderate and high ─ in the past 7 days.

Patients were deemed physically active if they scored in the high or moderate range. Patients who scored low were deemed physically inactive.

Premorbid functioning was assessed using the Premorbid Adjustment Scale (PAS), and positive and negative symptoms were assessed at baseline using the Scale for the Assessment of Positive Symptoms (PAS) and the Scale for the Assessment of Negative Symptoms (SAPS). Participants were assessed again at 6 months.

At 6 months, functioning was assessed using the Role Functioning Scale (RFS), which measures domains of work, independent living/self-care, immediate social network relationships, and extended social network relationships.

Simple, Inexpensive, Noninvasive

The results showed that 96 (33.9%) patients were physically inactive and 187 (66.1%) were physically active. The researchers note that there were no significant differences in clinical or demographic characteristics between the 2 study groups.

At 6 months, the researchers found that physically inactive patients had poorer functioning than active patients (RFS total score: 20.6 ± 3.9 vs 21.8 ± 3.4; t = -2.727; P = .007).

In addition to physical activity status, other significant predictors for functioning at 6 months included having more positive and negative symptoms and lower household income at baseline.

The results support the "hypothesis that physical activity plays a modulating role in functioning."

"Our postulation is that physical activity may contribute to a better functioning by improving cognition, symptoms and physical health. All these factors may affect physical activity in turn and they may play an important role of a virtuous cycle of functional improvement in psychosis."

The investigators report that they are planning a randomized, controlled trial to test the impact of different types of physical activity in FEP.

"As a simple, inexpensive, and non-invasive intervention, physical activity should be rigorously advocated to integrate into mental health care system, particularly during the critical period of early intervention for psychosis," the investigators conclude.

Dr. Lee reports that he sat on a scientific advisory board for AstraZeneca and Eli Lilly. Dr. Chen reports that he sat on a scientific advisory board for Otsuka and that he received educational grant support from Janssen-Cilag and research funding from AstraZeneca, Janssen-Cilag, Pfizer, Eli Lilly, sanofi-aventis, and Otsuka. All other authors report no relevant financial relationships.

Schizophr Res. 2013;150:538-541.

    
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