統合失調症患者への生活習慣の改善に向けた個別支援の試み—健康管理チェック表を用いた援助を振り返って

An individual approach to lifestyle improvement for a schizophrenic patient: Considering a health care check sheet approach

要旨：薬の副作用や生活習慣の乱れによる統合失調症患者の体重増加が問題視されている．統合失調症の健康管理に対する援助は患者の認知機能障害や陰性症状が影響するため，健康管理に向けた関心や意欲を高めながら取り組みを継続させる工夫が必要である．今回，ある肥満傾向の症例に対して健康管理チェック表を活用した個別的支援を導入し，精神症状や認知機能に対応した目標や活動量の設定，フィードバックによる動機づけや指導を行った．その結果，健康管理に対する動機が維持され，食生活や運動に対する意識や問題行動への対処能力が高まり減量につながった．チェック表を活用した援助は，個別的な体調に合わせた健康管理の支援として有用な取り組みであった．

　Schizophrenic patients often exhibit negative symptoms which contribute to a disturbed lifestyle and a dependence on atypical antipsychotics. This can result in adverse side effects, one such side effect being weight gain. Because an approach towards health care for schizophrenia is influenced by cognitive impairments of patients and negative symptoms, it is necessary to determine and continue an effective approach while increasing the patients' interest and motivation toward health care.

　In this study, an overweight subject was provided with individual therapy using a health care check sheet. The goal and level of exercise was developed considering the subject's psychotic symptoms and cognitive level. In addition, feedback was used to motivate and train the subject. As a result, motivation towards health care was maintained. Moreover, the patient's awareness and ability to cope with problem behavior associated with diet and exercise were enhanced, which led to weight loss. The approach using a health care check sheet was useful as an individual health care program.