| Abstract: | 背景: 肥胖是現代社會重要的健康議題, 肥胖的盛行率近年來不斷的升高 (Karnieli, 2008; Wyatt, Winters & Dubbert, 2006), 而病態肥胖和增加的心血管疾病 及整體死亡率有關(Pontiroli & Morabito, 2011)。對於病態肥胖的病人, 減重手術 可有效且有意義的持續地降低體重。對食物的衝動是導致肥胖的因素之一, 肥 胖患者中約 8%有暴食行為(Yanovski, 2003),減重手術後精神症狀如暴食行為會隨 著體重減少而改變, 若持續存在暴食行為則會影響預後。暴食在過去被認為是一 種控制不佳的酬賞行為, 或是被視為是成癮行為的一種,當前研究顯示其行為之 相關腦部區域遠比物質成癮影響廣泛(Tomasi & Volkow, 2013)。當前減重手術研究 對精神疾病術後變化的機轉尚未明朗, 包括手術後腦部神經傳導系統變化與暴 食行為及精神疾病的關聯性, 目前相關研究缺乏。進一步的了解術後生理改變及 精神疾病的變化相關性, 發展可偵測之生物指標, 應用於監測及改善肥胖共病之 精神疾患會是未來減重手術的多領域整合照顧的重要議題。 目的：有暴食行為的患者在減重手術前後會有症狀的變化, 比較手術前病態肥胖 族群中有暴食行為及沒有暴食行為族群間的差異去探討神經心理測驗(包含 visual probe task, symmetry span task, single-category implicit attitude test), 腦波 檢查與酬賞系統相關的腦區活化模式(resting-state MRI)是否可作為暴食行為的臨 床生物指標, 以及檢視減重手術前及手術後神經心理測驗及腦區活化模式的改 變是否和暴食行為變化一致。 方法：此為一前驅性追蹤研究。在橫斷研究部分, 由一區域教學醫院專門肥胖綜 合門診招募 30 位年齡 20-65 歲之間, 術前暴食自填量表(Binge Eating Scale) (Freitas, Lopes, Appolinario, et al, 2006)評估總分≧27 的病態肥胖患者以及由同一 門診招募 30 位量表分數≦17 且人口學資料及 BMI 相近之族群做為對照組。受試 者在參與研究時無服用精神藥物且無立即精神醫療介入之必要性, 如自殺意念 等。所有參加研究者均接受詳細研究說明並了解受試內容並簽署知情同意書, 之 後由研究護士完成自評量表收集及半結構式會談(包括精神疾患, 人格, 衝動, 自 殺企圖及憂鬱), 並在術前接受功能性磁振造影(resting-state MRI), 腦波檢查及進 行神經心理測驗。 追蹤研究部分,術前暴食自填量表評估總分≧27 之病患接受減重手術後第 6 及 12 個月接受半結構式會談(包括精神疾患,人格,衝動,自殺企圖及憂鬱程度)評估精神 疾病的變化, 並完成暴食自填量表評估, 腦波檢查, 及神經心理測驗。於術後第 12 個月追蹤腦部功能性磁振造影。 重要性：暴食行為對減重手術預後有不良影響, 此為第一篇在肥胖族群合併運 用功能性磁振造影影像, 腦波檢查及神經心理測驗去探索減重手術前後精神病 理改變之研究, 並藉此尋找此族群暴食行為相關的生物指標。 預期結果：對於易與肥胖共病之暴食行為, 可以增加臨床可應用之心理生物標 記, 協助全面及整合性的肥胖治療。 預期結果：此研究可找到在肥胖族群中暴食行為相關的心理生物標記, 如神經 心理測驗結果, 腦波及腦部功能性磁振造影影像變化, 以供臨床應用。
Background: obesity is an important health issue in modern society. The prevalence of obesity has been increasing in these years and morbid obesity is related to cardiovascular disease and overall mortality. Bariatric surgeries are effective and achieve significant and sustained body weight loss in patients with morbid obesity. Impulsivity toward eating is one of the factors leading to obesity. About 8% of obese patients have binge eating behaviors. Alteration of psychiatric symptoms such as binge eating after bariatric surgery was reported in literature. Some studies found improvement of psychiatric symptoms such as binge eating with the loss of body weight after bariatric surgery, while others rebutted. Persistence of binge eating will affect the prognosis of surgery. Past reviews regarded binge eating as a manifestation of dysfunctional reward system and disinhibition. Some authors considered binge eating as a kind of addiction. Recent study demonstrated the more extensive involvement of brain pathways other than reward system (Tomasi & Volkow, 2013). The mechanism of change is not clear. There is scanty of research regarding correlation between change of activation pattern in brain areas in functional MRI, binge eating and psychiatric illness. To gain insight into the correlation of physiological alteration and psychiatric illness and to develop subsequent detectable biomarker are crucial. Apply these novel markers to monitoring and improving cormorbid psychiatric illness will be an essential part of multidiscipline integral care for obese patients. Aims: To detect whether neuropsychological test (visual probe task, symmetry span task, single-category implicit attitude test), and resting state/task based fMRI can serve as a psychobiological markers for binge eating by comparing preoperative morbid obese patients with or without binge eating. To explore the change of neuropsychological test, EEG and resting state/task based fMRI as indicators for binge eating behaviors after the bariatric surgery. Methods: The study comprises two parts: a cross sectional part and a cohort. Thirty morbid obese participants aged between 20 and 65 years-old who are preparing to undergo bariatric surgery will be recruited from an obesity clinic in a single regional teaching hospital. The participants meet the criteria of severe binge eating defined by scores≧27 on Binge Eating Scale. The control group as comparison objects for the cross sectional study includes 30 subjects who are morbid obese, preparing to undergo bariatric surgery and scores≦17 on Binge Eating Scale. The control group will be recruited from the same clinic. All participants are not taking psychotropic agents during the study period and are not in need of immediate psychiatric intervention, such as suicidal ideation. Written informed consents are obtained after detailed description of the study is illustrated. A trained psychiatric nurse will carry out semi-structured interviews and evaluation of Binge Eating Scale. The participants receive neuropsychological tests, EEG, and resting state/task based fMRI before the bariatric surgery. The longitudinal cohort will comprise the same participant in the cross section study defined as morbid obese, preparing to undergo bariatric surgery and having severe binge eating behaviors. The clinic follows these patients by semi-structured psychiatric interview, Binge Eating Scale, EEG and neuropsychological tests at 6 and 12 months after the bariatric surgeries. The subjects received follow up resting state fMRI 12 months after surgery. Significance: This is the first study to apply EEG, functional neuroimaging, and neuropsychological test for evaluation the difference in patients before and after bariatric surgeries and we explore the possible binge eating biomarker in obese patients Anticipated results: The finding in this study will confirm the potential psychobiological biomarkers (EEG, neuroimaging and neuropsychological test results) for binge eating among obese patients. |
