精神分裂症患者体质量增加的非药物干预研究进展

doi:10.3969/j.issn.1674-8115.2024.05.012

上海交通大学学报（医学版） ›› 2024, Vol. 44 ›› Issue (5): 635-640.doi: 10.3969/j.issn.1674-8115.2024.05.012

• 综述 • 上一篇

精神分裂症患者体质量增加的非药物干预研究进展

陈小畅(), 张晨()

上海交通大学医学院附属精神卫生中心精神科，上海 200030

收稿日期:2023-10-23 接受日期:2024-02-27 出版日期:2024-05-28 发布日期:2024-05-28
通讯作者: 张晨 E-mail:chenxiaochang1998@163.com;zhangchen645@163.com
作者简介:陈小畅（1998—），女，硕士生；电子信箱：chenxiaochang1998@163.com。
基金资助:
国家自然科学基金(82271538);上海市青年科技启明星暨优秀学科带头人计划(20XD1403100);上海市科学技术委员会西医引导项目(19411969300)

Progress in non-pharmacological interventions for weight gain in schizophrenia

CHEN Xiaochang(), ZHANG Chen()

Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China

Received:2023-10-23 Accepted:2024-02-27 Online:2024-05-28 Published:2024-05-28
Contact: ZHANG Chen E-mail:chenxiaochang1998@163.com;zhangchen645@163.com
Supported by:
National Natural Science Foundation of China(82271538);Shanghai Youth Science and Technology Stars and Outstanding Discipline Leaders Program(20XD1403100);Western Medicine Guide Project of Science and Technology Commission of Shanghai Municipality(19411969300)

摘要/Abstract

摘要：

精神分裂症是一种慢性精神障碍，常常伴随着体质量增加问题，从而影响患者服药依从性、症状改善，并增加代谢性和心血管相关疾病的风险。然而，精神分裂症患者体质量增加的具体机制尚未完全明确，可能的原因包括抗精神病药物对多个神经递质受体的作用导致食欲增加和糖脂代谢异常，精神分裂症与肥胖之间的共同发病机制，以及精神分裂症患者不健康的饮食偏好和生活方式等。近年来非药物干预治疗精神分裂症患者体质量增加的研究成果不断更新，干预主要包括3种方式：生活方式干预、减重手术、神经调控技术。生活方式干预包括饮食、运动及认知等方面，目前探究综合性的生活干预模式的成效及患者依从性成为研究的主流；减重手术治疗对满足手术适应证的精神分裂症肥胖患者具有减重的效果，但目前报道的案例总数较少，且需要进一步探究围术期症状管理；神经调控技术治疗中重复经颅磁刺激（repeated transcranial magnetic stimulation，rTMS）对治疗精神分裂症患者的体质量增加具有潜在的前景。该文旨在为治疗精神分裂症患者体质量增加提供更多样化的临床策略参考。

关键词: 精神分裂症, 体质量增加, 生活方式干预, 减重手术, 神经调控技术

Abstract:

Schizophrenia is a chronic mental disorder that often co-occurs with weight gain issues, which impacts medication adherence and symptom recovery in patients, and increases the risk of metabolic and cardiovascular diseases. However, the specific mechanism of weight gain in the patients with schizophrenia remains incompletely understood. Potential factors include increased appetite and abnormal glucose and lipid metabolism due to the effects of antipsychotic drugs on multiple neurotransmitter receptors, shared pathogenesis between schizophrenia and obesity, and unhealthy dietary preferences and lifestyles among the patients with schizophrenia. In recent years, the progress in non-pharmacological interventions in the treatment of weight gain in schizophrenia has been continuously updated, which mainly includes lifestyle interventions, bariatric surgery and neuromodulation technology. Lifestyle interventions include diet, exercises and cognition, and the effectiveness of comprehensive lifestyle intervention models and compliance of patients have become the mainstream of research. Bariatric surgery has a weight loss effect on obese patients with schizophrenia who meet the surgical indications, but the total number of reported cases is still small, and further exploration of perioperative symptom management is needed. In neuromodulation technologies, repeated transcranial magnetic stimulation (rTMS) appears to be promising in the treatment of weight gain in the patients with schizophrenia. The aim of this article is to provide more diversified clinical strategies for the treatment of weight gain in schizophrenia.

Key words: schizophrenia, weight gain, lifestyle intervention, bariatric surgery, neuromodulation technology

中图分类号:

R749.3

陈小畅, 张晨. 精神分裂症患者体质量增加的非药物干预研究进展[J]. 上海交通大学学报（医学版）, 2024, 44(5): 635-640.

CHEN Xiaochang, ZHANG Chen. Progress in non-pharmacological interventions for weight gain in schizophrenia[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(5): 635-640.

参考文献 50

1	OWEN M J, SAWA A, MORTENSEN P B. Schizophrenia[J]. Lancet, 2016, 388(10039): 86-97.
2	TIAN Y, LIU D Y, WANG D M, et al. Obesity in Chinese patients with chronic schizophrenia: prevalence, clinical correlates and relationship with cognitive deficits[J]. Schizophr Res, 2020, 215: 270-276.
3	AFZAL M, SIDDIQI N, AHMAD B, et al. Prevalence of overweight and obesity in people with severe mental illness: systematic review and meta-analysis[J]. Front Endocrinol, 2021, 12: 769309.
4	FIRTH J, SIDDIQI N, KOYANAGI A, et al. The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness[J]. Lancet Psychiatry, 2019, 6(8): 675-712.
5	MAZEREEL V, DETRAUX J, VANCAMPFORT D, et al. Impact of psychotropic medication effects on obesity and the metabolic syndrome in people with serious mental illness[J]. Front Endocrinol, 2020, 11: 573479.
6	NIELSEN R E, BANNER J, JENSEN S E. Cardiovascular disease in patients with severe mental illness[J]. Nat Rev Cardiol, 2021, 18(2): 136-145.
7	SISKIND D, GALLAGHER E, WINCKEL K, et al. Does switching antipsychotics ameliorate weight gain in patients with severe mental illness? A systematic review and meta-analysis[J]. Schizophr Bull, 2021, 47(4): 948-958.
8	VANCAMPFORT D, FIRTH J, CORRELL C U, et al. The impact of pharmacological and non-pharmacological interventions to improve physical health outcomes in people with schizophrenia: a meta-review of meta-analyses of randomized controlled trials[J]. World Psychiatry, 2019, 18(1): 53-66.
9	AGARWAL S M, STOGIOS N, AHSAN Z A, et al. Pharmacological interventions for prevention of weight gain in people with schizophrenia[J]. Cochrane Database Syst Rev, 2022, 10(10): CD013337.
10	LEE K, ABRAHAM S, CLEAVER R. A systematic review of licensed weight-loss medications in treating antipsychotic-induced weight gain and obesity in schizophrenia and psychosis[J]. Gen Hosp Psychiatry, 2022, 78: 58-67.
11	SKOLNIK N S, RYAN D H. Pathophysiology, epidemiology, and assessment of obesity in adults[J]. J Fam Pract, 2014, 63(7 Suppl): S3-S10.
12	MONEM R G, OKUSAGA O O. Repetitive transcranial magnetic stimulation: a potential treatment for obesity in patients with schizophrenia[J]. Behav Sci, 2021, 11(6): 86.
13	DIPASQUALE S, PARIANTE C M, DAZZAN P, et al. The dietary pattern of patients with schizophrenia: a systematic review[J]. J Psychiatr Res, 2013, 47(2): 197-207.
14	MÖTTELI S, PROVAZNIKOVA B, VETTER S, et al. Examining nutrition knowledge, skills, and eating behaviours in people with severe mental illness: a cross-sectional comparison among psychiatric inpatients, outpatients, and healthy adults[J]. Nutrients, 2023, 15(9): 2136.
15	CORRELL C U, HØJLUND M, GRAHAM C, et al. Weight gain and metabolic changes in patients with first-episode psychosis or early-phase schizophrenia treated with olanzapine: a meta-analysis[J]. Int J Neuropsychopharmacol, 2023, 26(7): 451-464.
16	BARTON B B, SEGGER F, FISCHER K, et al. Update on weight-gain caused by antipsychotics: a systematic review and meta-analysis[J]. Expert Opin Drug Saf, 2020, 19(3): 295-314.
17	WU H, SIAFIS S, HAMZA T, et al. Antipsychotic-induced weight gain: dose-response meta-analysis of randomized controlled trials[J]. Schizophr Bull, 2022, 48(3): 643-654.
18	PILLINGER T, MCCUTCHEON R A, VANO L, et al. Comparative effects of 18 antipsychotics on metabolic function in patients with schizophrenia, predictors of metabolic dysregulation, and association with psychopathology: a systematic review and network meta-analysis[J]. Lancet Psychiatry, 2020, 7(1): 64-77.
19	JEON S W, KIM Y K. Unresolved issues for utilization of atypical antipsychotics in schizophrenia: antipsychotic polypharmacy and metabolic syndrome[J]. Int J Mol Sci, 2017, 18(10): 2174.
20	CUNNINGHAM J I, EYERMAN D J, TODTENKOPF M S, et al. Samidorphan mitigates olanzapine-induced weight gain and metabolic dysfunction in rats and non-human primates[J]. J Psychopharmacol, 2019, 33(10): 1303-1316.
21	MANU P, DIMA L, SHULMAN M, et al. Weight gain and obesity in schizophrenia: epidemiology, pathobiology, and management[J]. Acta Psychiatr Scand, 2015, 132(2): 97-108.
22	FALKAI P, SCHMITT A, ROSENBEIGER C P, et al. Aerobic exercise in severe mental illness: requirements from the perspective of sports medicine[J]. Eur Arch Psychiatry Clin Neurosci, 2022, 272(4): 643-677.
23	FERNÁNDEZ-ABASCAL B, SUÁREZ-PINILLA P, COBO-CORRALES C, et al. In- and outpatient lifestyle interventions on diet and exercise and their effect on physical and psychological health: a systematic review and meta-analysis of randomised controlled trials in patients with schizophrenia spectrum disorders and first episode of psychosis[J]. Neurosci Biobehav Rev, 2021, 125: 535-568.
24	ROMAIN A J, FANKAM C, KARELIS A D, et al. Effects of high intensity interval training among overweight individuals with psychotic disorders: a randomized controlled trial[J]. Schizophr Res, 2019, 210: 278-286.
25	SISMAN F N, BÜBER B, TAŞ F, et al. Randomized controlled trial for the effects of an exercise program for functional remission and weight control in schizophrenia: a community mental health study[J]. Issues Ment Health Nurs, 2022, 43(7): 603-612.
26	ZHANG L, ZHU M W, LIU X Q, et al. Calorie-restricted diet mitigates weight gain and metabolic abnormalities in obese women with schizophrenia: a randomized controlled trial[J]. Front Nutr, 2023, 10: 1038070.
27	DAUMIT G L, DICKERSON F B, WANG N Y, et al. A behavioral weight-loss intervention in persons with serious mental illness[J]. N Engl J Med, 2013, 368(17): 1594-1602.
28	CABASSA L J, STEFANCIC A, LEWIS-FERNÁNDEZ R, et al. Main outcomes of a peer-led healthy lifestyle intervention for people with serious mental illness in supportive housing[J]. Psychiatr Serv, 2021, 72(5): 555-562.
29	RAFN B S, ANDERSEN M F, SØRENSEN V, et al. Value of gym-based group exercise versus usual care for young adults receiving antipsychotic medication: study protocol for the multicenter randomized controlled Vega trial[J]. BMC Psychiatry, 2023, 23(1): 634.
30	LUCIANO M, SAMPOGNA G, AMORE M, et al. How to improve the physical health of people with severe mental illness? A multicentric randomized controlled trial on the efficacy of a lifestyle group intervention[J]. Eur Psychiatry, 2021, 64(1): e72.
31	MIDTGAARD J, SCHNOR H, BJERRE E D, et al. Exercise training complementary to specialised early intervention in patients with first-episode psychosis: a feasibility randomised trial[J]. Pilot Feasibility Stud, 2021, 7(1): 162.
32	TORTORELLA A. We should improve personalization of management in patients with a diagnosis of schizophrenia[J]. J Clin Med, 2021, 11(1): 184.
33	ARTERBURN D E, TELEM D A, KUSHNER R F, et al. Benefits and risks of bariatric surgery in adults: a review[J]. JAMA, 2020, 324(9): 879-887.
34	SUMITHRAN P, ROBERTS L, CATERSON I D, et al. Incidence of adverse mental health outcomes after sleeve gastrectomy compared with gastric bypass and restrictive bariatric procedures: a retrospective cohort study[J]. Obesity, 2023, 31(7): 1913-1923.
35	WARD H B, YUDKOFF B L, FROMSON J A. Lurasidone malabsorption following bariatric surgery: a case report[J]. J Psychiatr Pract, 2019, 25(4): 313-317.
36	ARCHID R, ARCHID N, MEILE T, et al. Patients with schizophrenia do not demonstrate worse outcome after sleeve gastrectomy: a short-term cohort study[J]. Obes Surg, 2019, 29(2): 506-510.
37	BRITO M E, SAMPAIO I M, FERREIRA A C, et al. Patients with schizophrenia undergoing gastric bypass surgery: a case series study[J]. Obes Surg, 2020, 30(10): 3813-3821.
38	LAGERROS Y T, BRANDT L, SUNDBOM M, et al. Risk of delayed discharge and reoperation of gastric bypass patients with psychiatric comorbidity: a nationwide cohort study[J]. Obes Surg, 2020, 30(7): 2511-2518.
39	SAMUELS J, CARMICHAEL H, HAZEL K, et al. Chronic psychiatric diagnoses increase emergency department utilization following bariatric surgery[J]. Surg Endosc, 2023, 37(3): 2215-2223.
40	KOUIDRAT Y, AMAD A, STUBBS B, et al. Surgical management of obesity among people with schizophrenia and bipolar disorder: a systematic review of outcomes and recommendations for future research[J]. Obes Surg, 2017, 27(7): 1889-1895.
41	LI Z J, ZHANG L B, CHEN Y X, et al. Advancements and challenges in neuromodulation technology: interdisciplinary opportunities and collaborative endeavors[J]. Sci Bull, 2023, 68(18): 1978-1982.
42	LEFAUCHEUR J P, ALEMAN A, BAEKEN C, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): an update (2014‒2018)[J]. Clin Neurophysiol, 2020, 131(2): 474-528.
43	KIM S H, CHUNG J H, KIM T H, et al. The effects of repetitive transcranial magnetic stimulation on body weight and food consumption in obese adults: a randomized controlled study[J]. Brain Stimul, 2019, 12(6): 1556-1564.
44	KIM S H, CHUNG J H, KIM T H, et al. The effects of repetitive transcranial magnetic stimulation on eating behaviors and body weight in obesity: a randomized controlled study[J]. Brain Stimul, 2018, 11(3): 528-535.
45	SU X R, WANG X, PAN X L, et al. Effect of repetitive transcranial magnetic stimulation in inducing weight loss in patients with chronic schizophrenia: a randomized, double-blind controlled 4-week study[J]. Curr Neuropharmacol, 2023, 21(2): 417-423.
46	DEVOTO F, FERRULLI A, ZAPPAROLI L, et al. Repetitive deep TMS for the reduction of body weight: bimodal effect on the functional brain connectivity in “diabesity”[J]. Nutr Metab Cardiovasc Dis, 2021, 31(6): 1860-1870.
47	FERRULLI A, DRAGO L, GANDINI S, et al. Deep transcranial magnetic stimulation affects gut microbiota composition in obesity: results of randomized clinical trial[J]. Int J Mol Sci, 2021, 22(9): 4692.
48	WHITING D M, TOMYCZ N D, BAILES J, et al. Lateral hypothalamic area deep brain stimulation for refractory obesity: a pilot study with preliminary data on safety, body weight, and energy metabolism[J]. J Neurosurg, 2013, 119(1): 56-63.
49	GLUCK M E, ALONSO-ALONSO M, PIAGGI P, et al. Neuromodulation targeted to the prefrontal cortex induces changes in energy intake and weight loss in obesity[J]. Obesity, 2015, 23(11): 2149-2156.
50	GRUNDEIS F, BRAND C, KUMAR S, et al. Non-invasive prefrontal/frontal brain stimulation is not effective in modulating food reappraisal abilities or calorie consumption in obese females[J]. Front Neurosci, 2017, 11: 334.

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精神分裂症患者体质量增加的非药物干预研究进展

Progress in non-pharmacological interventions for weight gain in schizophrenia

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