摘要
目的:分析社会基理论在精神病患者心理康复中的作用效果。方法:于2001-01/10选取西安市精神卫生中心康复科住院的符合CCMD-3精神分裂症的诊断标准的患者90例,随机分为社会基理论组和对照组,每组45例。常规抗精神病药物处理。社会基理论组采用社会基理论的基本方法对患者进行心理康复治疗,社会基理论的基本思想内容:①购物理论体现想买-了解-比较-选择-决定-行动-付款-领物行为心理模式。②入厕理论体现便意-有意识-无意识-固定-习惯行为心理模式。③牙与舌头理论体现事件-刺激-矛盾-寻找解决办法-选择-忍耐-宽容-化解行为心理模式。④白花与红花理论体现判断-选择-决定-爱好-环境-从新判断-选择-决定-放弃行为心理模式。⑤穿衣打伞理论体现预知-感知-选择-决定-适应行为心理模式。治疗6～12次,45～90min/次,应用临床疗效总评量表、住院用护士观察量表,日常生活能力量表、WHO社会功能缺陷筛选量表于治疗前及治疗90d后各评定1次,WHO社会功能缺陷筛选量表于出院6个月再评定1次;靶问题或行为于出院12个月再进行评定。随访采用信件、电话及入户调查、复诊询问等方法进行。评估标准:住院用护士观察量表减(增)率=[(入组时评定分-治疗末评定分)/入组时评定分×100%]:减(增)分率≥75%为症状消失,≥50%为显效,≥25%为有效,≤20%为无效。结果:两组患者均完成治疗及量表评定,全部进入结果分析。①两组患者治疗后住院用护士观察量表,日常生活能力量表、WHO社会功能筛选量表评定结果差异均有显著性意义(P<0.01)。②社会基理论组总显效率为51%(23例),有效率为91%(41例);对照组总显效率为31%(14例),有效率为62%(28例);两组差异有显著性意义(χ2=10.497,P<0.005)。③出院6个月时社会基理论组WHO社会功能缺陷筛选量表的职业和工作、社会性退缩、家庭外社会活动、家庭内活动过少、家庭职能、个人生活自理、责任心和计划评分与对照组比较差异均有显著性意义。④社会基理论组靶问题或行为(包括治疗依从性、人际关系、社会适应性、医患关系)明显好于对照组,⑤社会基理论组一年内复发率11%,3年复发率33%,对照组一年复发率27%,3年复发率53%。两组复发率差异有显著性意义(44%,80%,χ2=12.101,P<0.01)。结论:社会基理论的应用改善精神分裂症患者心理调节和自我保健,使之掌握自我控制的调适方法,避免复发的诱因,降低复发率,提高康复质量。具有可操作性。
AIM： To analyze the effect of society-based theory in the psychological rehabilitation of psychopath.
METHODS： Ninety patients, who were hospitalized in the Department of Rehabilitation, Xi ＇an Mental Health Center, were in accordance with the diagnostic standards for schizophrenia of the third edition of the Chinese Classification and diagnostic criteria of Mental Disorders （CCMD-3）, and they were randomly divided into society-based theory group （n=45） and control group （n=45）. Routine treatment of antipsyehotie drugs was given. The patients in the society-based theory group also received treatments of psychological rehabilitation by the basic method of society-based theory. The content of society-based theory included the following points： ① shopping theory, which reflected the behavioral psychological pattern of ＂want to buy-get the -selecting -deciding -action -pay for it-fetch it＂; ② entering toilet theory, which reflected the behavioral psychological pattern of ＂awareness of defecation-conscious-unconsciousfixation-habit＂; ③ teeth and tongue theory, which reflected the behavioral psychological pattern of ＂event-stimulation-contradiction-seeking for solution-selecting-enduranee-toleranee-solvement＂; ④ white flower and red flower theory, which reflected the behavioral psychological pattern of ＂judging-seleeting-deciding-interest-environment-judging again-selectingdeciding-giving up＂; ⑤ clothing and umbrella theory, which reflected the behavioral psychological pattern of ＂predicting-apperception-selectingdeciding-adaptation＂. The patients were treated for 6-12 times, 45-90 minutes for each time. They were evaluated once before treatment and at 90 days after treatment respectively clinical global impression （CGI）, nurses＇ observation scale for inpatient evaluation （NOSIE）, activity of daily living scale （ADL） and WHO social disability screening schedule （SDSS）, and they were assessed with SDSS again at 6 months after discharge. The target problem and or behavior was reasse^sed at 12 months after discharge. Patients were visited by means of letters, telephone, home investigation and subsequent visiting enquiry, etc. Evaluative standard： The decreasing （increasing） rate of NOSIE score=[（score at entering the groupscore at the end of treatment）/score at entering the group×100%], the decreasing （increasing） rate ≥75% for disappearance of symptoms,≥50% for significant effect, ≥25% for effective, ≥20% for invalid.
RESULTS： All the patients in both groups finished the treatment and evaluation, and entered the analysis of results. ① The scores of NOSIE, ADL and SSDS after treatment were all significantly different between the two groups （P〈 0.01）.② In the society-based theory group, the total significant effective rate was 51% （23 cases）, effective rate was 91% （41 cases）, which were significantly different from those in the control group [31% （14 cases）, 62% （28 cases）, X^2=10.497, P 〈 0.005]. ② At 6 months after discharge, the scores of profession and job, social withdrawal, social activities outside family, few activities inside family, family function, selfcare ability, responsibility and planning in SSDS in the society-based theory group were significantly different from those in the control group. ④ The target problems or behaviors （including therapeutic compliance, interpersonal relationship, social adaptability and doctor-patientrelationship） in the society-based theory group were obviously better than those in the control group. ⑤ The rates of relapse within 1 and 3 years were 11% and 33% in the society-based theory group, and 27% and 53 % in the control group. There were significant differences in the rate of relapse between the two groups （44%, 80%, X^2=12.101, P 〈 0.01）.
CONCLUSION： The application of society-based theory can ameliorate the mental adjustment and self health care of patients with schizophrenia, and make them grasp the methods for self-control adaptation, avoid the inducer for the relapse, reduce the rate of relapse and improve rehabilitative quality, and it is operatable.
出处
《中国临床康复》
CSCD
北大核心
2006年第18期32-34,共3页
Chinese Journal of Clinical Rehabilitation
