Health value for chronic schizophrenic patients with obesity

Abstract

Background and aims: Obesity is associated with excess energy intake Recent studies considered that overeating caused by antipsychotic drugs is not an indicator of obesity in chronic schizophrenia Past literature showed the relationship between neurocognitive deficits and obesity Not only obese individuals but also patients with schizophrenia has similar endophenotype Additionally health value is also related to obesity However there was few studies to examine the relationship between health value and obesity in chronic schizophrenic patients (CSZ) The current research comprised of three parts Firstly a meta-analysis was conducted to find the relationship between the prefrontal cortex and health value in people with normal weight and obesity Healthy people rather than CSZ were selected because no study discussed health value in CSZ yet Secondly an original study examined whether poor health value CSZ with obesity had influenced their food memory about health value Thirdly using a case study represented the effect of brain-based psychotherapy on reducing unhealthy eating behaviors in CSZ with obesity Methods: In study1 a systematic search of the literature was conducted Keyword searches included “health OR healthiness OR healthy food choices OR health value” AND “obesity” AND “prefrontal cortex ” We collected neural and functional data Four studies published in English up to August 2019 were identified through hand searches of the PubMed Embase and PsycINFO databases GingerALE version 3 0 2 and Comprehensive Meta-Analysis 2 0 were employed to analyze the data of the included studies The study 2 included 54 adults with chronic SZs at a psychiatric hospital in southern Taiwan divided into 2 groups based on body mass index (BMI); 27 in the obesity group [44% male mean (SD) age 40 22 (6 56) years] and 27 in the normal weight group [56% male mean age 40 59 (7 75) years] The clinical symptom assessment intelligence scale and a memory task for foods with health value were used for data collection In study 3 the participant was a 30-year-old female who was diagnosed with schizophrenia 8 years ago Although a graduate her work performance was inconsistent Her body mass index was over 40 By cognitive assessment impaired executive function was found Also she received several measures of eating behaviors including food memory updating the control of rewarding effect of food eating behavior questionnaire and visual analog scale for subjective willingness to eat The target of treatment was to improve neurocognitive deficits relating to unhealthy eating behaviors The strategy comprising of attentional control and metacognition was used to improve working memory and inhibition Training dosage was 3~4 sessions a week and each session was approximately 60 minutes The treatment consisted of fifty-two sessions Results: In study1 results indicated that different brain activations in manipulation of health mindset (top-down processing) between obese and normal weight individuals; chiefly in Brodmann areas 46 9 13 and 29 Studies using bottom-up processing did not display brain activation Effect sizes describing the difference between the evaluation of healthy and unhealthy food were close to medium (-0 44 and 0 43) In study 2 obesity and gender both affected food memory including immediate memory (ps < 01) and delayed memory (p < 02) Obese male participants had the poorest performance on the memory task Only obesity was significantly associated with intention consistent with memory about foods with health value such as twenty-four hours (p < 001) and seven days after (p < 08) the end of food memory In study 3 the participant’s executive function was improved Also she could update healthy food but not unhealthy food than before Besides the control of rewarding effect of food was improved during treatment However her willingness to eat healthy (decreasing) and unhealthy food (increasing) was changed Finally the awareness of eating behavior was better (from 13 to 21) and she cooked vegetables by herself During follow-up her improvement was maintained Discussions and conclusions: Study1 found that obese individuals had reduced activation of the right inferior and middle frontal gyrus when they tended to undertake health actions Hence the lower PFC activation might affect to hold health consciousness to select healthy food Obese individuals may “ignore” the association between health-promoting and foods whereas they seem to “neglect” the health threat of unhealthy foods Regarding health value it was a noticeable factor that influences the risk of obesity in CSZs Additionally male participants with obesity needed the treatment bringing health value to their consciousness efficiently The effect of brain-based psychotherapy seemed to reduce unhealthy eating behavior in CSZ with obesity We suggested using comparison groups to examine the training in the future

Date of Award	2020
Original language	English
Supervisor	Nai-Wen Guo (Supervisor)