运用激励技巧降低长期精神科住院患者的心血代谢风险因素：一项自然干预研究。
Using motivational techniques to reduce cardiometabolic risk factors in long term psychiatric inpatients: a naturalistic interventional study.
机构信息
Division of Mental Health and Addiction, Oslo University Hospital and NORMENT, KG Jebsen Centre, University of Oslo, Ullevål Hospital, P.O.Box 4956, 0424, Nydalen, Oslo, Norway.
Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, P.O.Box 4950, 0424, Nydalen, Oslo, Norway.
出版信息
BMC Psychiatry. 2018 Aug 15;18(1):255. doi: 10.1186/s12888-018-1832-6.
BACKGROUND
People with severe mental illness have markedly reduced life expectancy; cardiometabolic disease is a major cause. Psychiatric hospital inpatients have elevated levels of cardiometabolic risk factors and are to a high degree dependent of the routines and facilities of the institutions. Studies of lifestyle interventions to reduce cardiometabolic risk in psychiatric inpatients are few. The current study aimed at assessing the feasibility and effects of a lifestyle intervention including Motivational Interviewing (MI) on physical activity levels, cardiometabolic risk status and mental health status in psychotic disorder inpatients.
METHODS
Prospective naturalistic intervention study of 83 patients at long term inpatient psychosis treatment wards in South-Eastern Norway. Patients were assessed 3-6 months prior to, at start and 6 months after a life-style intervention program including training of staff in MI, simple changes in routines and improvements of facilities for physical exercise. Assessments were done by clinical staff and included level of physical activity, motivation, life satisfaction, symptom levels (MADRS, AES-C, PANSS, and GAF) as well as anthropometric and biochemical markers of cardiometabolic risk. A mixed model was applied to analyze change over time.
RESULTS
A total of 88% of patients received MI interventions, with a mean of 2.5 MI interventions per week per patient. The physical activity level was not increased, but activity level was positively associated with motivation and negatively associated with positive symptoms. Triglyceride levels and number of smokers were significantly reduced and a significant decrease in symptom levels was observed.
CONCLUSIONS
The current results suggest that a simple, low cost life-style intervention program focusing on motivational change is feasible and may reduce symptoms and improve lifestyle habits in psychosis patients in long term treatment facilities. Similar programs may easily be implemented in other psychiatric hospitals.
TRIAL REGISTRATION
ClinicalTrials.gov . NCT03528278 , date of registration: 05/16/2018 (retrospectively registered).
背景
患有严重精神疾病的人群预期寿命明显缩短；而心血管代谢疾病是主要原因。精神科住院患者存在较高水平的心血管代谢危险因素，并且在很大程度上依赖于机构的日常工作和设施。关于生活方式干预以降低精神科住院患者心血管代谢风险的研究很少。本研究旨在评估包括动机访谈（MI）在内的生活方式干预对精神分裂症住院患者的身体活动水平、心血管代谢风险状况和心理健康状况的可行性和效果。
方法
这是一项在挪威东南部长期住院精神病治疗病房进行的前瞻性自然干预研究。在生活方式干预计划开始前 3-6 个月、开始时和 6 个月后对 83 名患者进行评估，该计划包括培训工作人员进行 MI、简单改变常规和改善体育锻炼设施。评估由临床工作人员进行，包括身体活动水平、动机、生活满意度、症状水平（MADRS、AES-C、PANSS 和 GAF）以及心血管代谢风险的人体测量和生化标志物。采用混合模型分析随时间的变化。
结果
共有 88%的患者接受了 MI 干预，每位患者每周平均接受 2.5 次 MI 干预。身体活动水平没有增加，但活动水平与动机呈正相关，与阳性症状呈负相关。甘油三酯水平和吸烟者人数显著减少，症状水平显著下降。
结论
目前的结果表明，一种简单、低成本的生活方式干预计划，侧重于动机改变，是可行的，可能会降低精神病患者的症状并改善他们在长期治疗设施中的生活方式习惯。类似的方案很容易在其他精神病医院实施。
试验注册
ClinicalTrials.gov 。NCT03528278，注册日期：2018 年 5 月 16 日（回溯注册）。
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