精神障害者への健康管理プログラムの持続的効果─身体・認知内容の指標および認知機能による比較─

Long-term effects of health care programs on patients with mental illness: A comparison of body index, index of cognitive contents, and cognitive function

要旨：精神障害者が肥満によって生活習慣病に罹患するリスクが増大している．しかし，減量に向けた精神障害者の主体的な行動を維持することは難しい．そこで，体格指数（BMI）25以上のデイケア患者を対象に，動機づけの工夫や集団と個別のアプローチを織り交ぜた健康管理プログラムを約4ヵ月間実施し，介入後4ヵ月時（以下，追跡時）までの効果検討を行った．その結果，「適度な体重の維持ができる」，「体調の記録を継続できる」といった健康行動の自己効力感が追跡時も維持され，不規則な食事の改善やカロリーを意識した食行動の改善がみられた．この健康行動に対する認知や食行動の変容が，介入後の有意な体重の減少や追跡時の体重維持に影響したと考えた．

　It has been known that obese patients with mental illness have increased risk of lifestyle-related diseases. However, such patients have difficulty in maintaining independent actions toward weight loss. Therefore, a health care program were carried out on daycare patients with body mass index (BMI) ＞ 25 for approximately four months, and its effect at the time of follow-up was examined. The program consisted of group and individual motivational activity sessions. The results at follow up showed that the patients “were able to continue to track their physical condition”, and that “moderate weight could be maintained”. In addition, an improvement in dietary behaviors, such as monitoring of caloric intake and avoiding irregular meals, was seen. It is thought that the recognition of their health behavior and transformation of their dietary behavior influenced their weight maintenance at the time of follow-up, as well as their successful weight loss after the intervention.