摘要
目的:观察药物治疗配合心理治疗对慢性精神分裂症患者社会能力缺损的康复效果。方法:于2002-10/2004-10,选择兰州大学第二医院精神科收治的符合CCMD-Ⅲ-R诊断标准的慢性精神分裂症患者100例,随机分为药物治疗组和心理治疗组,各50例。两组均服用抗精神病药物,药物治疗组折合氯丙嗪(420±130)mg/d,心理治疗组折合氯丙嗪(430±110)mg/d。心理治疗组患者同时给予心理治疗。第1个月主要介绍精神分裂症疾病知识、症状对策、降低家庭情感表达、减轻家属的内疚自罪感,减少他们的心理负担和如何配合医生治疗。第2个月主要介绍病情特点,帮助其认识、提高,并介绍一些药物治疗常识,每周1次共4次。第3个月讨论如何面对家庭和社会,以及如何坚持服药定期复查,每周1次共4次。第4～5个月主要内容为家庭监护、家庭和精神健康、坚持服药和定期复查的具体问题;将患者分成组,互相帮助学习料理生活的习惯和技能,每周2次共4次。第6个月做出院前的准备,以1次个别辅导,1次集体心理治疗,主要内容是社会康复家庭心理教育。共进行16次的集体和个别心理治疗。采用简明精神卫生评定量表(7级评分:1无症状;2可疑或很轻;3轻度;4中度;5偏重;6重度;7极重度)评定治疗前、治疗后3,6个月总分及各因子分。结果:纳入患者100例,均进入结果分析。①心理治疗组治疗后6个月简明精神卫生评定量表评分较治疗前平均下降17.02分;药物治疗组较治疗前平均下降6.28分;两组间比较差异显著(t=4.66,10.17,P<0.01)。②心理治疗组简明精神卫生评定量表各因子在治疗阶段之间变化显著,活力因子、激活性因子增加更显著[治疗后6个月、治疗前活力因子分别为2.31±0.41,3.92±0.54,P<0.01;治疗后6个月、治疗前激活性因子分别为1.47±0.41,2.47±0.78,P<0.01]。③药物治疗组有效9例,无效41例,有效率为18%;心理治疗组有效34例,无效16例,有效率为68%;两组间比较差异显著(P<0.01)。④药物治疗组8例,心理治疗组6例出现锥体外系副反应,对症治疗后副反应消失。未发生其他副反应。结论:慢性精神分裂症患者药物治疗配合心理治疗较单纯药物治疗对改善社会能力效果明显。
AIM： To observe the rehabilitative effects of drug therapy plus psychotherapy on the defect of social ability in patients with chronic schizophrenia.
METHODS： Totally 100 patients with chronic schizophrenia, who were in accordance with the diagnostic criteria of the third edition of the Chinese Classification and diagnostic criteria of Mental Disorders （CCMD-3）, were selected from the Department of Psychology, Second Hospital of Lanzhou University from October 2002 to October 2004, and they were randomly divided into drug therapy group （n=50） and psychotherapy group （n=50）. The patients were given antipsychotic drug of chloropromazine of （420±130） and （430±110） mg per day in the drug therapy group and psychotherapy group respectively, besides those in the psychotherapy group also received psychotherapy. In the first month, the knowledge about schizophrenia, strategy of the symptoms, decreasing the family emotional expression, reducing the relatives＇ feelings of remorse and guilty, decreasing their psychological burden, and how to cooperate with the physician were mainly introduced. In the second month, the characters of disease were mainly introduced to help the patients to recognize and improve, knowledge about some drug therapies was also introduced, once a week for 4 times. In the third month, how to face the family and society and how to insist the drug administration and reexamine regularly were discussed, once a week for 4 times. In the fourth and fifth months, the main contents were the specific questions of family monitoring, family and mental health, insisting on drug administration and regular reexamination, the patients were grouped, and helped each other in the habits and skills of learning and living, twice a week for four times. In the sixth month, they prepared for discharge, individual guidance and group psychotherapy was given once respectively, the main content was the social rehabilitation family psychological education, the group and individual psychotherapies were given for 16 times. The patients were evaluated with mini-mental state examination （MMSE） before therapy and at 3 and 6 months after therapy respectively, the 7-grade scoring system was used： 1 for no symptom, 2 for doubtful or very mild, 3 for mile, 4 for moderate, 5 for a little severe, 6 for severe, 7 for extremely severe.
RESULTS： All the 100 patients were involved in the analysis of results. ① At 6 months after therapy, the score of MMSE was decreased averagely by 17.02 and 6.28 points as compared with that before therapy in the psychotherapy group and drug therapy group respectively, and there was significant difference between the two groups （t=4.66, 10.17, P 〈 0.01）. ② In the psychotherapy group, the factor scores of MMSE had significant differences during the therapy, and the factors of vigor and activation were increased more significantly （6 months after therapy and before therapy, score of vigor： 2.31±0.41, 3.92±0.54, P 〈 0.01; score of activation： 1.47±0.41, 2.47±0.78, P 〈 0.01）. ③ In the drug therapy group, the efficacy was effective in 9 cases and invalid in 41 cases, the effective rate was 18%; In the psychotherapy group, the efficacy was effective in 34 cases and invalid in 16 cases, the effective rate was 68%; there was significant difference between the two groups （P 〈 0.01）. ④The side effect of extrapyramidal system occurred in 8 cases of the drug therapy group and 6 cases of the psychotherapy group respectively, and the side effect disappeared after symptomatic treatment. Other side effects did not occur.
CONCLUSION： Drug therapy plus psychotherapy has obvious effect in ameliorating the social ability of patients with chronic schizophrenia than drug therapy mdy.
出处
《中国临床康复》
CSCD
北大核心
2006年第18期38-39,共2页
Chinese Journal of Clinical Rehabilitation
