生活方式的介入是否能使精神疾病病人體重下降?Whether lifestyle intervention can make patients with mental illness lose weight?

602 1 123

2023-09-27 已刊登
新刊登 綜 整 預防/治療/介入類型

作  者

呂沛玲 林文綾*

文章類別

B 類:實證健康照護應用

問題類型

治療/預防性問題

健康狀況

精神醫學 (Psychiatry)  

治療/介入措施

心理教育相關措施(Psycho-educational Intervention) - 生活方式介入涵蓋飲食、運動及行為修正

專長類別

精神衛生護理

中文關鍵詞

#精神疾病病人 #生活方式介入 #體重

英文關鍵詞

#Psychiatric patient #Lifestyle intervention #Weight

機構名稱

臺中榮民總醫院

申請單位

精神科病房

中文摘要

形成臨床提問:
慢性精神疾病病人肥胖盛行率高於一般人,於生理層面,肥胖為造成多種慢性疾病的危險因素之一,於心理與社會層面,肥胖使病人身體心像變差、低自尊心、缺乏自信心以及人際互動退縮。近年來,多項報告皆指出生活型態的改變,例如:飲食控制、運動及行為修正,可使減重效果顯著,達到健康體位。面對病人主動想減重的訴求,引發作者動機,藉由實證手法提出一個臨床問題,以研究對象(P)「精神病人(psychiatric patient)或(mental illness)」、介入措施(I)「生活方式的介入(lifestyle intervention)」、對照組(C)「常規照護(routine care)」及結果評估(O)「體重(weight)」為關鍵字,探討生活方式的介入是否能使精神疾病病人體重下降?
文獻搜尋的方法與分析:
運用實證護理5A步驟,搜尋PubMed、Embase、Cochrane Library及中文電子期刊(CEPS)等資料庫符合PICO問題者,搜尋2017年至2022年的文獻,搜尋策略運用關鍵字、相關字及MeSH Term搭配布林邏輯進行搜尋,共搜尋到六篇符合PICO的系統性文獻回顧。
文獻的品質評讀與結果:
運用2018年最新版CASP for SR評讀工具,評讀六篇系統性文獻回顧,依照The Oxford 2011 Levels of Evidence評定標準,證據等級為Level 1,建議強度評等為A。
證據之臨床應用:
依循實證轉譯7A步驟進行臨床應用。作者擬定生活方式介入措施為飲食、運動及行為修正,對象為台中某醫學中心日間病房BMI≧27 kg/m2且具有減重動機的五位病人,介入措施為六個月飲食控制及有氧運動訓練,每週五次,每次30分鐘,每個月測量體重,每天個別進行會談。
成效評值:
實證轉譯應用於臨床個案,經過六個月的介入,五位病人平均體重下降3.98公斤,最高下降10.6公斤,平均BMI下降1.4kg/m2,最高下降4.0 kg/m2。附加效益方面,提升病人自信心,更加注重個人儀容,也使其中一位因肥胖次發性停經女性病人月經可規則來潮。
結論與建議:
經由六個月的生活方式介入能使精神疾病病人體重下降,結果證實,動機與意願是影響減重成功與否的關鍵,建議必須持續追蹤,養成生活習慣,才能有效達到體重下降、長期體重控制之目的。

英文摘要

Ask an answerable question (PICO):
The prevalence of obesity in patients with chronic mental illness is higher than that in the general population. Obesity is one of the risk factors for many chronic diseases, it also makes patients’ physical and mental health worse, lowers self-esteem, lacks confidence and withdraws from interpersonal interaction. In recent years, many reports have pointed out that changes in lifestyle, such as dietary control, exercise and behavioral modification, can significantly reduce weight. According to the client has highly motivation for losing weight , we apply the evidence based intervention to propose a clinical problem. The PICO was (P) is “psychiatric patients or mental illness”, (I) are “lifestyle intervention”, (C) are “routine care” and outcome evaluation (O) is “weight” as keywords to explore whether lifestyle intervention can reduce weight in patients with mental illness?
The Method and Analysis of Literature Review:
Following the evidence-based nursing 5A steps, search PubMed, Embase, Cochrane Library and Chinese electronic journals (CEPS) and other databases that meet the PICO problem. Search for literature from 2017 to 2022. The search strategy uses keywords, related words and MeSH Term with Boolean logic for searching. A total of six systematic literature reviews that meet PICO were searched.
Critical Appraisal:
Using the latest version of CASP for SR appraisal tool in 2018, appraise six systematic literature reviews, the evidence level of those articles were evidence level 1 and the recommendation strength was grade A according to The Oxford 2011 Levels of Evidence rating criteria.
Clinical Application of Evidence:
Follow the 7A steps of evidence-based translation for clinical application. The author formulated lifestyle intervention measures for diet, exercise and behavioral modification. The subjects were five patients with BMI≧27 kg/m2 and weight loss motivation in the day ward of a medical center in Taichung. The intervention measures were six months of diet control and aerobic exercise training five times a week for 30 minutes each time. Weight was measured every month and individual counseling was conducted every day.
Evaluation of Effectiveness:
Evidence-based translation was applied to clinical cases. After six months of intervention, the average weight of the five patients decreased by 3.98 kg, with the highest decrease being 10.6 kg, and the average BMI decreased by 1.4 kg/m2, with the highest decrease being 4.0 kg/m2. In terms of additional benefits, it improved patients' confidence and made them pay more attention to personal appearance. It also made one of the female patients with obesity-induced secondary amenorrhea menstruate regularly again.
Conclusions and Recommendations:
After six months of lifestyle intervention, weight loss was achieved in patients with mental illness. The results confirmed that motivation and willingness are key factors affecting successful weight loss, and it is recommended to continue to follow up and develop good habits to achieve effective weight loss and long-term weight control.