| Objective:To investigate social-psychological factors associated with weight gain of first-episode schizophrenia patients in olanzapine therapy,in order to explor the effectiveness of early cognitive behavioral intervention prevented weight gain.1.To explore relationship between weight gain and social-psychological factors,which including attitude towards food,response inhibition,social and family-related factors,life style,to provide empirical foundation support for early cognitive behabioral intervention strategies.2.To determine the influence of olanzapine on food attitude,to evaluate feasibility of evaluative conditioning training as intervention strategies strengthening the cognitive association of “low fat and low calorie foods-positive” to prevent weight gain,to assess the efficacy of early behavioral intervention to prevent olanzapine-induced weight gain.Methods:The present study was divided into the following two parts.1.Cross-sectional survey.sixty outpatiens with first-episode schizophrenia with olanzapine during 3~ 6months.Through the questionnaire survey to collect the patient's general demographic and social family information,life style,behavior impulsivity and explicit attitude towards food.Using signal stop task and implicit association test to detect response inhibition function and implicit attitude towards food in patients.2.Control study.Patients with first-episode and untreated schizophrenia,a total of sixty,according to admission order into three groups: healthy controls group,cognitive behavioral intervention group,and cognitive behavioral intervention+evaluative conditioning(EC)group,each group of 20 patients.Intervention therapy for one month,four times,once a week,90 minutes each time.Cognitive behavioral intervention in the form of group counseling,Cognitive behavioral intervention+EC training on the basis of group intervention,give EC training in the form of individual consulting,50 minutes each time strengthened the cognitive association of “low fat and low calorie foods-positive”.A questionnaire survey was conducted before and after the intervention respectively and the corresponding behavior examination,studing patients' attitude towards food,response inhibition and impulsivity change.Compared the change trend of weight gain,body mass index and waist circumference in the three groups,to evaluate feasibility of evaluative conditioning training as intervention strategies strengthening the cognitive association of “low fat and low calorie foods-positive” to prevent weight gain,to assess the efficacy of early behavioral intervention to prevent olanzapine-induced weight gain.Result:1.Weight gain associating with social psychological factors of clinically stable outpatiens in first-episode with schizophrenia.(1)For the implicit attitude towards food,all of the patients have a positive attitude towards low fat and low calorie foods.Compare to weight gain?7.0%,outpatient weight gain<7.0% prefers low fat and low calorie foods(P<0.05).For the explicit attitude towards food,there was no significant difference between low fat and high fat foods(P>0.05),Compared weight gain<7.0%,outpatient weight gain?7.0% prefers high fat and high calorie foods(P<0.05).For the outpatient weight gain<7.0%,there was positively correlations between implicit and explicit attitudes towards foods(P<0.05),Outpatient weight gain?7.0%,no significant correlation was found between implicit and explicit attitudes towards foods(P>0.05).(2)The reaction inhibition function,Compared to outpatient weight gain<7.0%,outpatient weight gain?7.0% stop-signal delay was shorter(P<0.05).No other difference was revealed on behavioral indicators.(3)In terms of social-family factors,the level of education influences weight gain(P<0.05),in that the higher education is,the less weight gain.(4)In terms of life style factors,physical exercise habits also affect weight gain,there was a significant difference(P<0.05).Patients with physical exercise habits had less weight gain.2.The effect of early cognitive behavioral intervention on the prevention of the weight gain in first-episode patients with schizophrenia.(1)Giving early cognitive behavior intervention in order to manage weight gain while olanzapine treatment.Control group,cognitive behavioral intervention,cognitive behavior+EC training group,these groups of patients weight gain,body mass index,waist circumference changes existed different change trend in different time-node.After olanzapine treatment 24 weeks,there were significant differences between the three groups(P<0.05).Cognitive behavioral intervention group +EC group weight gain at least,the cognitive behavioral intervention group weight gain is moderate,control group weight gain at most.(2)Olanzapine treatment for 4 weeks.Before and after the treatment,the control group of patients for implicit food attitude did not occur significant change(P>0.05).The explicit food attitude had significant change(P<0.05),their performance of the explicit attitude of high fat and high calorie food more positive.Giving early cognitive behavior intervention while olanzapine treatment,in cognitive behavior intervention group,the implicit attitude towards food did not occur significant change(P>0.05),the explicit attitude towards food had significant change(P<0.05),showed a preference for low fat and low calorie food;In cognitive behavior intervention +EC group,before and after training,patients implicit and explicit attitude towards food had significant change(P<0.05).After intervention,there was a positive correlation between implicit and explicit attitude towards food(P<0.05),with a preference for low fat and low calorie food.(3)The performance of signal stop task in the first episode and untreated schizophrenia patients was significantly lower than that in the healthy control group(P<0.05);After four weeks of treatment with olanzapine,patients were able to complete more difficulty inhibition task(P<0.05),the performance on the stop signal task increased significantly(P<0.05),but still lower than that of healthy control group;There was no significant difference between the patients and the control group in the total score of BIS-11 and sub scores(attentional impulse,motor impulse,nonplanning impulse)(P>0.05);After 4 weeks of treatment with olanzapine,BIS-11 score and sub scores had no significant difference before and after treatment respectively(P>0.05).Before and after treatment with olanzapine,BIS-11 scores of patients and sub surface points and the signal stop task behavior index had no correlation(P>0.05).Conclusion:1.Outpatiens with no clinically significant weight gain,their implicit and explicit attitudes towards foods were positively correlated(P<0.05),they prefer low fat and low calorie foods.Defection of reaction inhibition negatively influences weight gain.High level of education and physical exercise were protective factors for weight gain.2.In first-episode schizophrenia patients with olanzapine treatment,patient's explicit attitude on the high fat and high calorie foods was more positive;Cognitive behavioral intervention,cognitive behavioral intervention+EC training could inhibit the effects of olanzapine drugs on the attitude towards food in different degrees;Cognitive behavioral intervention +EC training was beneficial to the long-term effect of maintaining the body mass,and EC training was an effective strategy for cognitive introduction;Schizophrenia patients at the early stage of the disease had deficit in the response inhibition,and their behavior impulsivity has not been affected. |
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