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系統識別號 U0026-0601202005030700
論文名稱(中文) 健康價值於肥胖的慢性思覺失調症
論文名稱(英文) Health value for chronic schizophrenic patients with obesity
校院名稱 成功大學
系所名稱(中) 健康照護科學研究所
系所名稱(英) Institute of Allied Health Sciences
學年度 108
學期 1
出版年 108
研究生(中文) 葉品陽
研究生(英文) Pin-Yang Yeh
學號 TA8001025
學位類別 博士
語文別 英文
論文頁數 90頁
口試委員 指導教授-郭乃文
召集委員-陳正宗
口試委員-楊延光
口試委員-謝碧玲
口試委員-吳景寬
中文關鍵字 思覺失調症  肥胖  健康價值  食物記憶  飲食行為 
英文關鍵字 Schizophrenia  Obesity  Health value  Food memory  Eating behavior 
學科別分類
中文摘要 研究背景與目標:肥胖常與過分攝取能量有關。近期研究指出,抗精神病藥物引起的過度飲食不適合解釋慢性思覺失調症的肥胖問題。過去文獻已顯示神經認知功能缺損與肥胖間的關係。過度肥胖者與思覺失調症者也有相似的內在表現型(endophenotype)。此外,健康價值被發現亦與肥胖有關。然而,鮮有研究檢驗慢性思覺失調症者的肥胖與健康價值間的關聯。本研究包含三個部分:首先,利用後設分析方式檢驗前額葉與健康價值於正常體重與肥胖者的關係。未採用肥胖慢性思覺失調症為對象,主因是未搜尋到該族群與健康價值間的研究。第二,本論文採用一篇原創研究驗證一個假設,即肥胖的慢性思覺失調症之健康價值薄弱,致無法記得具健康價值的食物,甚至影響後續食物意圖。第三,以一個案研究形式進行神經心理治療,改善肥胖思覺失調症的不健康飲食行為。
研究方法:研究一採用系統文獻搜尋,採用關鍵字為“health 或 healthiness 或 healthy food choices 或 health value” 與“obesity” 與 “prefrontal cortex”。搜尋的電子資料庫為PubMed, Embase, and PsycINFO,時限至2019年八月,最後有四個研究符合篩選標準。資料分析工具為GingerALE version 3.0.2 and Comprehensive Meta-Analysis 2.0。研究二招募到54名慢性失調失調症者,依身體質量指數(BMI)分成肥胖組(BMI>27)與正常體重(BMI<24)。正常體重與肥胖組各有27名。肥胖組男性為44%,平均年齡40.22歲。正常體重組男性為56%,平均年齡40.59歲。採用評估工具有,臨床症狀、智力測驗與食物健康價值之記憶作業。研究三,個案為30歲女性,八年前確診為思覺失調症。雖然大學畢,但工作不穩定。BMI超過40。神經心理衡鑑發現,與前額葉有關的執行功能有障礙。另外,她也接受幾個飲食行為的評估,包括:食物工作記憶的更新能力、食物酬賞反應的抑制、飲食行為問卷與主觀飲食意願。治療目標為涉及不健康飲食行為的神經心理功能障礙(工作記憶與抑制能力),治療對策為注意力控制與後設認知能力。治療劑量為每週3至4次,共52次。每次約60分鐘。
研究結果:研究一顯示,以肥胖與正常體重者使用健康思維(health mindset)面對食物時,兩者的布羅德曼區(Brodmann areas) 46, 9, 13與 29有明顯差異。雖然兩者於評價食物健康與否未有腦區活動的差異,但於健康(-0.44)與不健康食物(0.43)的效果量有顯著差別(ps<.04)。研究二發現,肥胖與性別同樣會影響食物記憶:立即記憶(ps<.01)與延宕記憶(p<.02)。然而,肥胖的男性患者表現最差。只有肥胖能影響後續飲食意圖,例如:24小時後想吃健康食物(p<.001),七天後想吃健康食物(p<.08)。研究三,受試者的執行功能被改善。此外,她也更能有效更新健康食物的記憶,而不健康食物則否。再者,治療過程中她更能有效控制食物的酬賞反應。但是,自陳報告卻出現分歧結果,飲食問卷有進步(從13增加至21),但主觀想吃健康食物意願卻下降,且想吃不健康食物上升。30天後的追蹤顯示,個案的療效多能維持。
討論與結論:研究一發現,當肥胖者想採取健康思維改善飲食時,其額下與中回活性卻變差,如此可能造成他們無法維持健康價值選擇健康食物。此外,肥胖者可能會忽略食物與健康間的關聯,而低估食物與健康威脅的連結。研究二中,健康價值確實影響肥胖思覺失調者的食物記憶,且以男性尤甚。換言之,男性思覺失調症更應該採取相關介入。研究三的個案療效報告中,以大腦為基礎的心理治療改善不健康飲食頗具效果,期望日後能有相關對照組療效研究加以支持。
英文摘要 Background and aims: Obesity is associated with excess energy intake. Recent studies considered that overeating caused by antipsychotic drugs is not an indicator of obesity in chronic schizophrenia. Past literature showed the relationship between neurocognitive deficits and obesity. Not only obese individuals but also patients with schizophrenia has similar endophenotype. Additionally, health value is also related to obesity. However, there was few studies to examine the relationship between health value and obesity in chronic schizophrenic patients (CSZ). The current research comprised of three parts. Firstly, a meta-analysis was conducted to find the relationship between the prefrontal cortex and health value in people with normal weight and obesity. Healthy people rather than CSZ were selected because no study discussed health value in CSZ yet. Secondly, an original study examined whether poor health value CSZ with obesity had influenced their food memory about health value. Thirdly, using a case study represented the effect of brain-based psychotherapy on reducing unhealthy eating behaviors in CSZ with obesity.
Methods: In study1, a systematic search of the literature was conducted. Keyword searches included “health OR healthiness OR healthy food choices OR health value” AND “obesity” AND “prefrontal cortex.” We collected neural and functional data. Four studies published in English up to August 2019 were identified through hand searches of the PubMed, Embase, and PsycINFO databases. GingerALE version 3.0.2 and Comprehensive Meta-Analysis 2.0 were employed to analyze the data of the included studies. The study 2 included 54 adults with chronic SZs at a psychiatric hospital in southern Taiwan, divided into 2 groups based on body mass index (BMI); 27 in the obesity group [44% male, mean (SD) age 40.22 (6.56) years] and 27 in the normal weight group [56% male, mean age 40.59 (7.75) years]. The clinical symptom assessment, intelligence scale, and a memory task for foods with health value were used for data collection. In study 3, the participant was a 30-year-old female who was diagnosed with schizophrenia 8 years ago. Although a graduate, her work performance was inconsistent. Her body mass index was over 40. By cognitive assessment, impaired executive function was found. Also, she received several measures of eating behaviors, including food memory updating, the control of rewarding effect of food, eating behavior questionnaire and visual analog scale for subjective willingness to eat. The target of treatment was to improve neurocognitive deficits relating to unhealthy eating behaviors. The strategy comprising of attentional control and metacognition was used to improve working memory and inhibition. Training dosage was 3~4 sessions a week, and each session was approximately 60 minutes. The treatment consisted of fifty-two sessions.
Results: In study1, results indicated that different brain activations in manipulation of health mindset (top-down processing) between obese and normal weight individuals; chiefly in Brodmann areas 46, 9, 13 and 29. Studies using bottom-up processing did not display brain activation. Effect sizes describing the difference between the evaluation of healthy and unhealthy food were close to medium (-0.44 and 0.43). In study 2, obesity and gender both affected food memory, including immediate memory (ps <.01) and delayed memory (p <.02). Obese male participants had the poorest performance on the memory task. Only obesity was significantly associated with intention consistent with memory about foods with health value, such as twenty-four hours (p <.001) and seven days after (p <.08) the end of food memory. In study 3, the participant’s executive function was improved. Also, she could update healthy food, but not unhealthy food, than before. Besides, the control of rewarding effect of food was improved during treatment. However, her willingness to eat healthy (decreasing) and unhealthy food (increasing) was changed. Finally, the awareness of eating behavior was better (from 13 to 21), and she cooked vegetables by herself. During follow-up, her improvement was maintained.
Discussions and conclusions: Study1 found that obese individuals had reduced activation of the right inferior and middle frontal gyrus when they tended to undertake health actions. Hence, the lower PFC activation might affect to hold health consciousness to select healthy food. Obese individuals may “ignore” the association between health-promoting and foods, whereas they seem to “neglect” the health threat of unhealthy foods. Regarding health value, it was a noticeable factor that influences the risk of obesity in CSZs. Additionally, male participants with obesity needed the treatment bringing health value to their consciousness efficiently. The effect of brain-based psychotherapy seemed to reduce unhealthy eating behavior in CSZ with obesity. We suggested using comparison groups to examine the training in the future.
論文目次 摘要…………………………………………………………………………………II
SUMMARY…………………………………………………………………………V
致謝…………………………………………………………………………………IX
TABLE OF CONTENTS…………………………………………………………....X
LIST OF TABLES…………………………………………………………………..XII
LIST OF FIGURES………………………………………………………………...XIII
LIST OF ABBREVATION………………………………………………………....XIV
1 LITERATURE REVIEW ……………………………………………………………1
1.1 BACKGROUND …………...……………………………………………….….1
1.2 THE RELATIONSHIP BETWEEN REWARD-BASED EXCESS ENERGY INTAKE AND OBESITY……………………………..……………………………3
1.3 THE ASSOICATION BETWEEN REWARD-BASED EXCESS ENERGY INTAKE AND EXECUTIVE DYSFUNCTION………………………………..…..6
1.4 RELATIONSHIP OF SCHIZOPHRENIA-INDUCED COGNITIVE DEFICITS AND OBESITY……………………………………………………………………11
1.5 AIMS OF RESEARCH………………………………………………………..14
2 STUDY 1…………………………………………………………………………...15
2.1 BACKGROUND……………………………………………………………....15
2.2 METHODS…………………………………………………………………….19
2.3 RESULTS…………………………………………………………………...…25
2.4 DISCUSSION…………………………………………………………………31
2.5 CONCLUSION………………………………………………………………..34
3 STUDY 2…………………………………………………………………………..35
3.1 BACKGROUND AND HYPOTHESIS………………………………………35
3.2 METHODS……………………………………………………………………39
3.3 RESULTS……………………………………………………………………..45
3.4 DISCUSSION…………………………………………………………………52
4 STUDY 3…………………………………………………………………………...56
4.1 BACKGROUND……………………………………………………………...56
4.2 CASE ANALYSIS…………………………………………………………….59
4.3 TRAINING PLAN FOR IMPROVING EATING BEHAVIORS……….…….63
4.4 EVALUATION OF TRAINING EFFECT…………………………………….66
4.5 DISCUSSION…………………………………………………………………70
REFERENCE………………………………………………………………………...74
APPENDIX I……………….………………………………………………………..90
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