运动对于早期精神病是有效的介入方式?


  【24drs.com】运动似乎可以预测首次发作精神病(FEP)患者的功能,这个发现认为运动可以作为帮助此类患者改善结果的早期介入方式。
  
  香港大学进行的一篇大型研究发现,FEP病患的运动程度可显著预测6个月后的功能结果。Edwin H. M. Lee医师等研究者写道,6个月时,运动力较差的病患,其功能结果比有活动力的病患差。
  
  这篇研究登载于11月的Schizophrenia Research期刊。
  
  研究者指出,越来越多人探讨运动对于FEP患者心理和生理健康的影响;对一般人而言,不运动及生理疾病引起的死亡与失能率较高有关,也与认知功能不佳及整体认知衰退风险增加有关。
  
  研究认为不运动所累积的影响加上使用抗精神病药物,使精神分裂症患者的死亡率风险进一步增加。
  
  研究者指出,探讨运动和功能之关系的精神分裂症研究大多数是在有慢性疾病的病患进行。
  
  这次的研究检视年纪25-55岁的283名FEP患者的运动和功能盛行率,这些病患招募自一项成年发作精神病的早期介入服务;研究开始时评估他们的运动程度、社会人口统计学资料与临床特征。
  
  使用国际运动问卷(IPAQ)评估运动情况,这个问卷可以测量过去7天内,花在走路的时间以及运动的强度(低、中、高);如果病患的评分为高或中度,则被视为有运动,评分为低度则视为不运动。
  
  使用发病前适应量表(PAS)评估发病前功能,使用正向症状评估量表(SAPS )和负向症状评估量表(SANS)评估开始时的正向和负向症状;在6个月时再度评估这些研究对象。
  
  6个月时,使用角色功能量表(RFS)评估功能,这个量表可测量工作领域,独立生活/自理,直接的社会网络关系,以及扩展的社会网络关系。
  
  研究结果显示,96名(33.9%)患者属于不运动,187名(66.1%)属于有运动。研究者指出,这两组在临床或人口统计学特征上并无显著差异。
  
  6个月时,研究者发现,不运动组病患的功能比运动组患者差(RFS总分: 20.6 ± 3.9 vs 21.8 ± 3.4;t = -2.727;P = .007)。
  
  除了运动状态,6个月时功能的其它显著预测因子,包括在研究开始时有比较多的正向和负向症状以及较低的家庭收入。
  
  研究结果支持「运动对于功能有调节角色」之假设。
  
  作者们的假设是,运动可以藉由改善认知、症状和生理健康而获得比较好的功能;这些因素最终都会影响运动,对于精神病之功能改善的良性循环扮演重要角色 。
  
  研究者报告指出,他们正计划一项随机控制试验,探讨不同类型运动对于FEP患者的影响。
  
  研究者结论指出,运动是一种简单、不贵且非侵入性的介入方式,大力呼吁将运动整合到心智健康照护体系,特别是精神病早期介入的关键时期。
  
  资料来源: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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