收稿日期: 2023-10-23
录用日期: 2024-02-27
网络出版日期: 2024-05-28
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
Received date: 2023-10-23
Accepted date: 2024-02-27
Online published: 2024-05-28
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)
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。
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 . DOI: 10.3969/j.issn.1674-8115.2024.05.012
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.
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