关于精神分裂症患者代谢综合征发病影响因素的研究以及舞蹈运动疗法的干预效果

《Frontiers in Psychiatry》：Research on the influencing factors of the development of metabolic syndrome in patients with schizophrenia and the intervention effect of dance movement therapy

精神分裂症患者代谢综合征影响因素及舞蹈运动疗法干预效果研究，发现年龄、吸烟、高BMI、IL-6和CRP水平是风险因素，适度运动具保护作用，DMT可降低干预组BMI、腰围、DBP及PANSS评分，优于对照组（

　　
schizophrenia patients is a critical clinical issue. This study systematically explored the influencing factors of MS in schizophrenia and evaluated the intervention effect of Dance Movement Therapy (DMT). The research identified that advanced age, smoking habits, elevated BMI and IL-6 levels, prolonged medication duration, and elevated CRP levels significantly increased the risk of MS. Conversely, moderate exercise habits emerged as a protective factor. The DMT intervention demonstrated efficacy in improving metabolic parameters (BMI, waist circumference, diastolic blood pressure) and psychological symptoms (PANSS scores) compared to conventional treatment alone. The findings highlight the importance of early risk stratification and non-pharmacological interventions in mitigating MS-related complications.

The study's design incorporated a prospective cohort analysis with 160 schizophrenia patients (80 MS group vs 80 non-MS group) followed by a randomized controlled trial (40 intervention vs 40 control) in the MS group. Baseline comparisons revealed significant differences in key variables including age, BMI, smoking status, medication duration, IL-6 levels, and CRP elevation between MS and non-MS groups. Logistic regression analysis confirmed these factors as independent predictors of MS development, with smoking (OR 3.917) and IL-6 elevation (OR 63.568) showing particularly strong associations. The protective role of moderate exercise (OR 0.238) was also statistically significant.

The DMT intervention protocol spanned 8 weeks with structured group activities divided into four phases: group formation, experiential creation, interaction development, and reconstruction separation. This multi-stage approach integrated rhythmic movements, non-verbal expression, and social interaction components. The intervention group showed progressive improvements in metabolic parameters (BMI decreased 5.2%, waist circumference reduced 3.8 cm) and PANSS scores (total score decreased 18.7%) compared to controls, where parameters demonstrated upward trends. Notably, the intervention group achieved clinically significant improvements in waist circumference (exceeding the 3-5 cm threshold recommended by IDF guidelines) and diastolic blood pressure.

The discussion reveals potential mechanisms linking DMT to metabolic benefits. The therapy's psychosomatic integration likely enhances insulin sensitivity through reduced stress hormones and improved lipid metabolism. Mirror neuron activation during group activities may facilitate emotional regulation, indirectly affecting metabolic parameters. However, the study also identified limitations including single-center design, short intervention period, and lack of long-term follow-up. These factors suggest the need for expanded research across diverse populations and extended observation periods.

Key clinical implications emerge from the findings. First, the identified risk factors (advanced age, smoking, prolonged medication) and protective factors (exercise) provide actionable targets for MS prevention. Clinicians should prioritize smoking cessation programs and metabolic monitoring for elderly patients with prolonged antipsychotic therapy. Second, the DMT intervention's dual benefits on metabolic and psychiatric parameters highlight its potential as a cost-effective complementary therapy, particularly in early MS stages. Third, the observed sex hormone influence on MS risk (via IL-1β regulation) suggests gender-specific metabolic pathways that warrant further investigation.

Methodological strengths include rigorous blinding procedures (researchers unaware of group assignments), standardized measurement protocols (BMI, waist circumference, PANSS), and comprehensive statistical analysis (multiple imputation for missing data, non-parametric tests for non-normal distributions). The use of partial eta-square effect sizes (η2) in ANOVA (0.11 for BMI, 0.18 for WC) provided quantitative insights into treatment effects. However, the study's single-center design and limited sample size (n=80 MS group) may affect generalizability. The 20% attrition rate also raises questions about potential bias from dropouts.

The DMT intervention's efficacy appears to result from its multifaceted approach:
1. Physical components (rhythmic movements, group exercises) improve mobility and energy expenditure
2. Psychological benefits (emotional expression, reduced stress) enhance medication adherence
3. Social interactions (group activities, shared experiences) counteract isolation tendencies

Notably, while SBP showed no significant change, the consistent reduction in DBP (8.7 mmHg at 8 weeks) and metabolic parameters (TC 15.3 mg/dL, LDL-C 22.1 mg/dL) suggest specific vascular and lipid metabolism benefits. The study's 8-week intervention duration aligns with prior DMT research but may be insufficient for long-term metabolic effects. The observed 18.7% PANSS score reduction indicates potential cognitive benefits through emotional regulation mechanisms.

Limitations require cautious interpretation. The single-center design (from a specific hospital in China) limits external validity. While the study controlled for major confounders (age, gender, medication history), residual confounding from unmeasured variables (genetic predisposition, exact caloric intake) may still exist. The short follow-up period (8 weeks) doesn't capture full disease progression or regression dynamics. Additionally, the therapeutic effect on lipid parameters (TC, LDL-C) was less pronounced than on weight-related metrics, suggesting DMT's metabolic impact may be more pronounced in obesity-related components.

Future research directions should focus on:
1. Multi-center replication with larger sample sizes (n>200)
2. Extended follow-up periods (6-12 months)
3. Mechanistic studies on IL-6/CRP pathways and mirror neuron activation
4. Comparisons with other exercise therapies (yoga,太极)
5. Cost-effectiveness analysis for integrated MS management

The clinical significance lies in demonstrating that DMT can effectively address both metabolic and psychiatric symptoms in schizophrenia patients, providing a sustainable alternative to pharmacological interventions. The study's findings support the integration of DMT into chronic disease management protocols for schizophrenia, particularly for early MS prevention. However, implementation challenges including therapist training, session scheduling, and cost-benefit analysis require further exploration before widespread adoption.

The research contributes new evidence to the growing body of literature on exercise therapies in mental health. While prior studies have shown benefits of aerobic exercise, DMT's unique combination of rhythmic movement and emotional expression appears particularly effective for patients with cognitive impairments and social withdrawal. The findings align with neurobiological theories suggesting that physical activity modulates HPA axis function and reduces systemic inflammation, both of which are critical in MS prevention for schizophrenia patients.

In summary, this study establishes a causal relationship between modifiable lifestyle factors (smoking, exercise) and metabolic syndrome development in schizophrenia. The DMT intervention demonstrates promising efficacy in improving both metabolic parameters and psychiatric symptoms, with particular impact on weight-related metrics and negative symptom reduction. While important limitations remain, the findings provide a strong foundation for developing comprehensive MS management strategies that combine pharmacological optimization with evidence-based psychosomatic interventions.