社区综合干预模式对精神分裂症患者康复效果的影响研究
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摘要
目的探讨社区综合干预模式对精神分裂症患者康复效果的影响。方法选取2005年1月—2016年1月新乡市国家严重精神障碍信息系统中的精神分裂症在管患者150例,并随机分为家庭护理教育组、社交技能康复训练组、综合干预组3组,每组50例。所有患者均根据病情接受相应的常规药物治疗。在此基础上家庭护理教育组患者及其家属接受精神分裂症相关内容的知识培训;社交技能康复训练组患者及其家属接受社交技能康复训练;综合干预组患者接受家庭护理教育组和社交技能康复训练组中所有干预措施,持续干预3个月。干预前、干预后6个月和12个月时,分别采用阳性和阴性症状量表(PANSS)、康复状态量表(MRSS)、社会功能缺陷筛选量表(SDSS)评估患者的精神症状严重程度、康复状况及社会功能。结果干预期间患者死亡2例、失访1例、中途退出2例,最终纳入的患者分别为家庭护理教育组49例、社交技能康复训练组48例、综合干预组48例,共计145例。3组PANSS、MRSS、SDSS得分比较,差异有统计学意义(P<0.05);不同时间点比较,差异有统计学意义(P<0.05);组别和时间在PANSS、MRSS、SDSS得分上存在交互作用(P<0.05)。其中,干预后6个月和12个月时,综合干预组和家庭护理教育组、社交技能康复训练组PANSS、MRSS、SDSS得分比较,差异有统计学意义(P<0.05);家庭护理教育组和社交技能康复训练组PANSS、MRSS、SDSS得分比较,差异有统计学意义(P<0.05)。3组干预后1年内精神分裂症复发率比较,差异有统计学意义(P<0.05)。结论社区综合干预模式能有效降低精神分裂症患者精神症状严重程度,改善康复状况和社会功能,并降低干预后1年内精神分裂症复发率。
Objective To explore the effects of community-based comprehensive interventions on the rehabilitation of schizophrenia patients. Methods Based on the inclusion and exclusion criteria, from Xinxiang National Register Information System for Severe Mental Disorders, we enrolled 150 schizophrenic patients under management from January 2005 to January 2016 and equally randomized them into home-based care and education group, social skills rehabilitation training group and comprehensive intervention group. In addition to the conventional medical treatment, patients in home-based care and education group, social skills rehabilitation training group, comprehensive intervention group and their family members were given schizophrenic knowledge training, rehabilitation training about social skills, schizophrenic knowledge training combined with rehabilitation training about social skills, respectively. The interventions for all groups lasted for 3 months. The mental symptoms, rehabilitation status and social functioning were assessed by Positive and Negative Symptoms Scale(PANSS),Morningside Rehabilitation Status Scale(MRSS) and Social Disability Screening Schedule(SDSS) before intervention and at 6,12 months after intervention, respectively. Results The final participants were 145 cases(49 in home-based care and education group, 48 in social skills rehabilitation training group and 48 in comprehensive intervention group) after excluding 2 deaths during intervention, 1 case lost to follow-up and 2 withdrawals. The average scores of PANSS, MRSS and SDSS measured before intervention, and at 6, 12 months after intervention differed significantly between the groups(P<0.05). Contents and duration of intervention produced interaction effects on the scores of PANSS, MRSS, and SDSS in all groups(P<0.05). At both 6, 12 months after intervention, compared with other two groups, comprehensive intervention group demonstrated significantly different average scores of PANSS, MRSS and SDSS(P<0.05); home-based care and education group and social skills rehabilitation training group had obviously different average scores of PANSS, MRSS and SDSS(P<0.05). The recurrence rate of schizophrenia within 1 year after intervention differed significantly among the three groups(P<0.05). Conclusion Community-based comprehensive interventions can effectively alleviate the schizophrenia symptoms, improve the rehabilitation status and social functioning, as well as reduce the recurrence rate within 1 year after intervention in schizophrenic patients.
Objective To explore the effects of community-based comprehensive interventions on the rehabilitation of schizophrenia patients. Methods Based on the inclusion and exclusion criteria, from Xinxiang National Register Information System for Severe Mental Disorders, we enrolled 150 schizophrenic patients under management from January 2005 to January 2016 and equally randomized them into home-based care and education group, social skills rehabilitation training group and comprehensive intervention group. In addition to the conventional medical treatment, patients in home-based care and education group, social skills rehabilitation training group, comprehensive intervention group and their family members were given schizophrenic knowledge training, rehabilitation training about social skills, schizophrenic knowledge training combined with rehabilitation training about social skills, respectively. The interventions for all groups lasted for 3 months. The mental symptoms, rehabilitation status and social functioning were assessed by Positive and Negative Symptoms Scale(PANSS),Morningside Rehabilitation Status Scale(MRSS) and Social Disability Screening Schedule(SDSS) before intervention and at 6,12 months after intervention, respectively. Results The final participants were 145 cases(49 in home-based care and education group, 48 in social skills rehabilitation training group and 48 in comprehensive intervention group) after excluding 2 deaths during intervention, 1 case lost to follow-up and 2 withdrawals. The average scores of PANSS, MRSS and SDSS measured before intervention, and at 6, 12 months after intervention differed significantly between the groups(P<0.05). Contents and duration of intervention produced interaction effects on the scores of PANSS, MRSS, and SDSS in all groups(P<0.05). At both 6, 12 months after intervention, compared with other two groups, comprehensive intervention group demonstrated significantly different average scores of PANSS, MRSS and SDSS(P<0.05); home-based care and education group and social skills rehabilitation training group had obviously different average scores of PANSS, MRSS and SDSS(P<0.05). The recurrence rate of schizophrenia within 1 year after intervention differed significantly among the three groups(P<0.05). Conclusion Community-based comprehensive interventions can effectively alleviate the schizophrenia symptoms, improve the rehabilitation status and social functioning, as well as reduce the recurrence rate within 1 year after intervention in schizophrenic patients.
引文
[1]王金荣,王德平,沈渔邨,等.中国七个地区情感性精神障碍流行病学调查[J].中华精神科杂志,1998,31(2):75-77.DOI:10.3760/j:issn:1006-7884.1998.02.004.WANG J R,WANG D P,SHEN Y C,et al.Epidemiological survey on affective disorder in 7 areas of China[J].Chinese Journal of Psychiatry,1998,31(2):75-77.DOI:10.3760/j:issn:1006-7884.1998.02.004.
[2]张维熙,沈渔,李淑然,等.中国七个地区精神疾病流行病学调查[J].中华精神科杂志,1998,31(2):69-71.DOI:10.3760/j:issn:1006-7884.1998.02.002.ZHANG W X,SHEN Y,LI S R,et al.Epidemiological investigation on mental disorders in 7 areas of China[J].Chinese Journal of Psychiatry,1998,31(2):69-71.DOI:10.3760/j:issn:1006-7884.1998.02.002.
[3]ANDREASEN N C.Symptoms,signs,and diagnosis of schizophrenia[J].Lancet,1995,346(8973):477-481.
[4]MUESER K T,BELLACK A S,DOUGLAS M S,et al.Prevalence and stability of social skill deficits in schizophrenia[J].Schizophr Res,1991,5(2):167-176.DOI:0920-9964(91)90044-R.
[5]BELLACK A S,SCHOOLER N R,MARDER S R,et al.Do clozpine and risperidone affect social competence and problem solving[J].Am Jpsychiatry,2004,161(2):364-367.DOI:10.1176/appi.ajp.161.2.364.
[6]翁永振.精神分裂症的康复操作手册[M].北京:人民卫生出版社,2009.
[7]马胜民,翁永振,卢苓,等.医院内职业康复对精神症状的影响[J].临床精神医学杂志,2001,11(4):205-206.DOI:10.3969/j.issn.1005-3220.2001.04.005.MA S M,WENG Y Z,LU L,et al.The influence of hospitalized occupational rehabilitation on psychiatric symptoms[J].Journal of Clinical Psychological Medicine,2001,11(4):205-206.DOI:10.3969/j.issn.1005-3220.2001.04.005.
[8]中华医学会精神科分会.中国精神障碍分类与诊断标准[M].3版.济南:山东科学技术出版社,2001.
[9]郗玲燕,黄秀芹,朱凤英,等.不同精神残疾程度的精神分裂症患者精神症状比较分析[J].中国全科医学,2015,18(10):1208-1211.DOI:10.3969/j.issn.1007-9572.2015.10.026.XI L Y,HUANG X Q,ZHU F Y,et al.Comparison of psychiatric symptoms of schizophrenia patients at different levels of mental disability[J].Chinese General Practice,2015,18(10):1208-1211.DOI:10.3969/j.issn.1007-9572.2015.10.026.
[10]柳群方,朱紫青.Morningside康复状态量表的信度和效度研究[J].上海精神医学,1998,10(3):147-149.LIU Q F,ZHU Z Q.Reliability and validity of Morningside Rehabilitation State Scale[J].Shanghai Archives of Psychiatry,1998,10(3):147-149.
[11]郭红利,崔奎友,陶玉芬,等.社区综合性精神康复措施对精神分裂症患者的康复作用[J].中国神经精神疾病杂志,2009,35(7):430-432.DOI:10.3969/j.issn.1002-0152.2009.07.015.GUO H L,CUI K Y,TAO Y F,et al.Comprehensive intervention effects on community rehabilitation of patients with schizophrenia[J].Chinese Journal of Nervous and Mental Diseases,2009,35(7):430-432.DOI:10.3969/j.issn.1002-0152.2009.07.015.
[12]徐奇,姚志珍,吴留发,等.社区日间康复训练对慢性精神分裂症患者的康复效果评价[J].中国全科医学,2014,17(19):2287-2290.DOI:10.3969/j.issn.1007-9572.2014.19.030.XU Q,YAO Z Z,WU L F,et al.Effects of day rehabilitation training in community for the patients with chronic schizophrenics[J].Chinese General Practice,2014,17(19):2287-2290.DOI:10.3969/j.issn.1007-9572.2014.19.030.
[13]仝历历,刘南华.精神病防治康复社区干预研究[J].现代临床医学,2007,33(6):417-419.DOI:10.3969/j.issn.1673-1557.2007.06.007.TONG L L,LIU N H.Study on community intervention about mental disease prevention and recovery[J].Journal of Modern Clinical Medicine,2007,33(6):417-419.DOI:10.3969/j.issn.1673-1557.2007.06.007.
[14]KOPELOWICZ A,LIBERMAN R P.Integrating treatment with rehabilitation for persons with major mental illnesses[J].Psychiatr Serv,2003,54(11):1491-1498.DOI:10.1176/appi.ps.54.11.1491.
[15]李启堂,刘国友,宋君伟,等.综合干预对社区精神分裂症患者的康复作用[J].中国健康心理学杂志,2016,24(7):979-982.DOI:10.13342/j.cnki.cjhp.2016.07.006.LI Q T,LIU G Q,SONG J W,et al.Comprehensive intervention effects on community rehabilitation of patients with schizophrenia[J].China Journal of Health Psychology,2016,24(7):979-982.DOI:10.13342/j.cnki.cjhp.2016.07.006.
[16]王延祜,唐济生,柴新生,等.社区综合干预对精神分裂症患者社会康复效果的对照研究[J].精神医学杂志,2009,22(4):244-246.DOI:10.3969/j.issn.1009-7201.2009.04.002.WANG Y H,TANG J S,CHAI X S,et al.Comparative study of effects of comprehensive intervention in community on schizophrenic social rehabilitation[J].Journal of Psychiatry,2009,22(4):244-246.DOI:10.3969/j.issn.1009-7201.2009.04.002.
[2]张维熙,沈渔,李淑然,等.中国七个地区精神疾病流行病学调查[J].中华精神科杂志,1998,31(2):69-71.DOI:10.3760/j:issn:1006-7884.1998.02.002.ZHANG W X,SHEN Y,LI S R,et al.Epidemiological investigation on mental disorders in 7 areas of China[J].Chinese Journal of Psychiatry,1998,31(2):69-71.DOI:10.3760/j:issn:1006-7884.1998.02.002.
[3]ANDREASEN N C.Symptoms,signs,and diagnosis of schizophrenia[J].Lancet,1995,346(8973):477-481.
[4]MUESER K T,BELLACK A S,DOUGLAS M S,et al.Prevalence and stability of social skill deficits in schizophrenia[J].Schizophr Res,1991,5(2):167-176.DOI:0920-9964(91)90044-R.
[5]BELLACK A S,SCHOOLER N R,MARDER S R,et al.Do clozpine and risperidone affect social competence and problem solving[J].Am Jpsychiatry,2004,161(2):364-367.DOI:10.1176/appi.ajp.161.2.364.
[6]翁永振.精神分裂症的康复操作手册[M].北京:人民卫生出版社,2009.
[7]马胜民,翁永振,卢苓,等.医院内职业康复对精神症状的影响[J].临床精神医学杂志,2001,11(4):205-206.DOI:10.3969/j.issn.1005-3220.2001.04.005.MA S M,WENG Y Z,LU L,et al.The influence of hospitalized occupational rehabilitation on psychiatric symptoms[J].Journal of Clinical Psychological Medicine,2001,11(4):205-206.DOI:10.3969/j.issn.1005-3220.2001.04.005.
[8]中华医学会精神科分会.中国精神障碍分类与诊断标准[M].3版.济南:山东科学技术出版社,2001.
[9]郗玲燕,黄秀芹,朱凤英,等.不同精神残疾程度的精神分裂症患者精神症状比较分析[J].中国全科医学,2015,18(10):1208-1211.DOI:10.3969/j.issn.1007-9572.2015.10.026.XI L Y,HUANG X Q,ZHU F Y,et al.Comparison of psychiatric symptoms of schizophrenia patients at different levels of mental disability[J].Chinese General Practice,2015,18(10):1208-1211.DOI:10.3969/j.issn.1007-9572.2015.10.026.
[10]柳群方,朱紫青.Morningside康复状态量表的信度和效度研究[J].上海精神医学,1998,10(3):147-149.LIU Q F,ZHU Z Q.Reliability and validity of Morningside Rehabilitation State Scale[J].Shanghai Archives of Psychiatry,1998,10(3):147-149.
[11]郭红利,崔奎友,陶玉芬,等.社区综合性精神康复措施对精神分裂症患者的康复作用[J].中国神经精神疾病杂志,2009,35(7):430-432.DOI:10.3969/j.issn.1002-0152.2009.07.015.GUO H L,CUI K Y,TAO Y F,et al.Comprehensive intervention effects on community rehabilitation of patients with schizophrenia[J].Chinese Journal of Nervous and Mental Diseases,2009,35(7):430-432.DOI:10.3969/j.issn.1002-0152.2009.07.015.
[12]徐奇,姚志珍,吴留发,等.社区日间康复训练对慢性精神分裂症患者的康复效果评价[J].中国全科医学,2014,17(19):2287-2290.DOI:10.3969/j.issn.1007-9572.2014.19.030.XU Q,YAO Z Z,WU L F,et al.Effects of day rehabilitation training in community for the patients with chronic schizophrenics[J].Chinese General Practice,2014,17(19):2287-2290.DOI:10.3969/j.issn.1007-9572.2014.19.030.
[13]仝历历,刘南华.精神病防治康复社区干预研究[J].现代临床医学,2007,33(6):417-419.DOI:10.3969/j.issn.1673-1557.2007.06.007.TONG L L,LIU N H.Study on community intervention about mental disease prevention and recovery[J].Journal of Modern Clinical Medicine,2007,33(6):417-419.DOI:10.3969/j.issn.1673-1557.2007.06.007.
[14]KOPELOWICZ A,LIBERMAN R P.Integrating treatment with rehabilitation for persons with major mental illnesses[J].Psychiatr Serv,2003,54(11):1491-1498.DOI:10.1176/appi.ps.54.11.1491.
[15]李启堂,刘国友,宋君伟,等.综合干预对社区精神分裂症患者的康复作用[J].中国健康心理学杂志,2016,24(7):979-982.DOI:10.13342/j.cnki.cjhp.2016.07.006.LI Q T,LIU G Q,SONG J W,et al.Comprehensive intervention effects on community rehabilitation of patients with schizophrenia[J].China Journal of Health Psychology,2016,24(7):979-982.DOI:10.13342/j.cnki.cjhp.2016.07.006.
[16]王延祜,唐济生,柴新生,等.社区综合干预对精神分裂症患者社会康复效果的对照研究[J].精神医学杂志,2009,22(4):244-246.DOI:10.3969/j.issn.1009-7201.2009.04.002.WANG Y H,TANG J S,CHAI X S,et al.Comparative study of effects of comprehensive intervention in community on schizophrenic social rehabilitation[J].Journal of Psychiatry,2009,22(4):244-246.DOI:10.3969/j.issn.1009-7201.2009.04.002.