稳定期精神分裂症的综合治疗效果及相关因素分析
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摘要
目的:探索影响稳定期精神分裂症患者认知功能和其它临床特征的相关因素,比较单用第二代抗精神病药治疗与药物结合心理社会康复治疗稳定期精神分裂症的有效性和安全性,为筛选出一套适合我国国情,能改善精神分裂症预后的综合治疗干预模式提供理论依据。
方法:1.研究对象:研究样本来源于上海市精神卫生中心2005年7月至2006年3月间的门诊随访患者137例,将样本随机分入4大组,其中维思通组29例,再普乐组44例,思瑞康组36例,博思清组28例。
2.研究方法:将每一药物大组又随机分配为单纯药物维持治疗组(简称单纯组)70例,药物结合心理社会康复组(简称综合组)67例。综合组患者分成4个组,每组16至17人且成员固定,综合干预治疗内容包括精神卫生健康教育、社会技能训练、职业功能康复训练和心理治疗。精神卫生健康教育、社会技能训练和心理治疗每月治疗1次,共6次。职业功能康复训练每3月治疗1次,共2次。在筛选期和6月末予阳性症状和阴性症状评定量表(PANSS)、Montogmery-Asberg抑郁量表(MADRS)、副反应量表(TESS)、健康状况调查问卷(SF-36)、社会功能缺陷筛选量表(SDSS)、日常生活能力量表(ADL)、生活事件量表(LES)等量表评定,以及认知检查包括威斯康星卡片分类测验(WCST)、连续作业测验(CPT)、连线测验(TMTA和TMTB)、中国修订韦氏记忆量表(WMS-RC)的视觉再生和中国修订韦氏成人智力量表(WAIS-RC)的数字符号、数字广度,3月末予PANSS、MADRS、TESS等量表评定。
3.数据统计:根据数据分布特点,运用描述性统计分析、X~2检验、多因素逐步回归分析、Logistic多因素回归分析、方差分析、t检验、Pearson相关分析等统计学方法,采用SPSS13.0统计软件包完成有关统计过程。
结果:1.稳定期精神分裂症患者的认知功能受发病年龄、性别、教育程度、药物和精神病理症状的影响。稳定期精神分裂症患者的精神病理症状与社会功能、日常生活能力、疾病家庭负担相关。已婚患者的阴性症状和抑郁症状总分低于未婚患者,男性患者的疾病家庭负担总分高于女性患者。
2.综合组六月末一般病理学量表总分(P＜0.01)和PANSS总分(P＜0.05)显著低于单纯组,TMTB完成时间显著少于单纯组(P＜0.05),社会功能、日常生活能力总分显著低于单纯组(P＜0.05),疾病家庭负担中的家庭成员心理健康分值显著低于单纯组(P＜0.05),生活质量的改善优于单纯组。
3.综合组内,大学组六月末的抑郁症状总分低于高中及以下组(P＜0.05),疾病家庭负担中的家庭日常活动总分低于高中及以下组(P＜0.05)。阿立派唑组阴性症状的改善优于其它三组。
4.稳定期精神分裂症患者PANSS总分、疾病家庭负担总分和负性生活事件值越高,生活质量越差。PANSS一般病理学量表减分率和日常生活能力量表减分率越高,生活质量的改善越显著。
5.奎硫平较常出现嗜睡(X~2=8.687 P＜0.05),利培酮较常出现肌强直(X~2=7.809 P＜0.05),奥氮平较常出现体重增加(X~2=12.370 P＜0.01)。
结论:1.稳定期精神分裂症患者的认知功能受多种因素的影响。
2.婚姻对稳定期精神分裂症患者的精神病理症状有保护作用。
3.稳定期精神分裂症患者的精神病理症状仍是影响社会功能、日常生活能力、疾病家庭负担和生活质量的根本原因。
4.综合治疗对稳定期精神分裂症患者的认知功能、精神病理症状、社会功能、日常生活能力、疾病家庭负担和生活质量均有改善作用。教育程度较高患者的综合治疗效果较好。阿立哌唑有利于综合组阴性症状的改善。
5.四种第二代抗精神病药的副作用存在差异,治疗应根据患者的耐受性不同选择药物。
6.可通过继续本研究的随访,更完整和准确的判断综合治疗的疗效,同时进一步了解稳定期精神分裂症患者长期预后和结局。
Objective:To explore the influencing factors on cognitive function and other clinical characters of stable schizophrenia.Compare the effect of integrated treatment group and control group.The study is aimed to provide corresponding basis for integrated treatment modle which can improve the stable schizophrenia patient's outcome used in our country.
Methods:1.137 outpatients in Shanghai Mental Health Central from July in 2005 to March in 2006,all the patients are cured by only one kind of Second Generation Antipsychotics.There are 29 patients in Risperidone group,44 patients in Zyprexa group,36 patients in Seroquel group,28 patients in Brisking group.2.Every antipsychotics group was randomly divided into control group and integrated treatment group,integrated treatment was additionally combined with bio-psycho-social intervention which included healthy education,social skills training, vocational rehabilitation and psychotherapy.There were 70 patients in control group and 67 patients in integrated treatment group.Integrated treatment group was divided into 4 groups,every group which fixed had 16 or 17 patients,healthy education, social skills training and psychotherapy were carried out one times every month,and vocational rehabilitation was carried out one times every 3 months.All subjects were evaluated using Positive and Negative Syndrome Scale(PANSS),Montgomery and Asberg Depression Rating Scale(MADRS),Treatment Emergent Symptom Scale (TESS),Family Burden Scale(FBS)every 3 months,and Short-Form-36 Health Survey(SF-36),Social Disability Screening Schedule(SDSS),Activity of Daily Living scale(ADL),Life Events Scale(LES)every 6 months.Cognitive function which included Wisconsion Card Sorting Test(WCST),Continuous Performance Test(CPT), Trail Making Test(TMTA and TMTB),Digit Symbol and Digit Span in Wechsler Adult Intelligence Scale Revised in China(WAIS-RC),Visual Reproduction in Wechsler Memory Scale-Revised in China(WMS-RC)was evaluated every 6 months.3.Statistical approaches such as t test,anova analysis,Pearson's x~2 statistics,Stepwise multiple regression analyses,Logistic regression analysis,Pearson correlation analysis were employed to analyze the data according to the characteristic of the distribution of data. The statistical software used throughout the analysis was SPSS13.
Results:1.Cognitive function of stable schizophrenia patients were influenced by age,gender,education level,antipsychotics and psychosis symptom.The patients' psychosis symptom showed significantly correlation with SDSS,ADL and FBS. Married patients' negative and depression symptom's score was significantly higher than un-married patients.2.After 6 months,integrated treatment group's score of PANSS general pathology scale(P＜0.01),PANSS total score(P＜0.05),SDSS (P＜0.05)and ADL'S(P＜0.05)score were significantly lower than control group. Integrated treatment group spent less time to finish the TMTB test than control group (P＜0.01).The score of relative's mental health in FBS is significantly lower than control group(P＜0.05).The improvement of quality life in integrated treatment group was better than control group.3.In integrated treatment group,college group's depression symptom and family daily activity in FBS'S score were lower than high school and below group(P＜0.05).The improvement of negative symptom in Aripiprazole group is better than other groups.4.The higher of PANSS,FBS and LES negative life event's score,the lower of the quality life.The higher of PANSS general pathology and ADL score reduction rate,the better improvement of the quality life.5.The side effect of too much sleep is more frequency on quetiapine(x~2 =8.687 P＜0.05),extrapyramidal side effect is more frequency on risperidone(x~2 =7.809 P＜0.05),weight gain is more frequency on olanzapine(x~2 =12.370 P＜0.01).
Conclusion:1.Cognitive function of stable schizophrenia was influenced by many factors.2.Marriage could protect stable schizophrenia patients' psychosis symptom. 3.Psychosis symptom is the reason of stable schizophrenia patients' lower social function and quality life and higher family burden.4.Integrated treatment would improve stable schizophrenia patients' cognitive function,psychosis symptom,social function,family burden and quality of life better than control group.The effect of integrated treatment for higher education patients is better.Aripiprazole could improve negative symptom in integrated group.5.The side effect of four kinds of second generation antipsychotic is different,so it should be choose by the patients' tolerance.6.Continue this study for a longer time would judge the Integrated treatment more credibly,and explore the stable schizophrenia patients' long term outcome.
方法:1.研究对象:研究样本来源于上海市精神卫生中心2005年7月至2006年3月间的门诊随访患者137例,将样本随机分入4大组,其中维思通组29例,再普乐组44例,思瑞康组36例,博思清组28例。
2.研究方法:将每一药物大组又随机分配为单纯药物维持治疗组(简称单纯组)70例,药物结合心理社会康复组(简称综合组)67例。综合组患者分成4个组,每组16至17人且成员固定,综合干预治疗内容包括精神卫生健康教育、社会技能训练、职业功能康复训练和心理治疗。精神卫生健康教育、社会技能训练和心理治疗每月治疗1次,共6次。职业功能康复训练每3月治疗1次,共2次。在筛选期和6月末予阳性症状和阴性症状评定量表(PANSS)、Montogmery-Asberg抑郁量表(MADRS)、副反应量表(TESS)、健康状况调查问卷(SF-36)、社会功能缺陷筛选量表(SDSS)、日常生活能力量表(ADL)、生活事件量表(LES)等量表评定,以及认知检查包括威斯康星卡片分类测验(WCST)、连续作业测验(CPT)、连线测验(TMTA和TMTB)、中国修订韦氏记忆量表(WMS-RC)的视觉再生和中国修订韦氏成人智力量表(WAIS-RC)的数字符号、数字广度,3月末予PANSS、MADRS、TESS等量表评定。
3.数据统计:根据数据分布特点,运用描述性统计分析、X~2检验、多因素逐步回归分析、Logistic多因素回归分析、方差分析、t检验、Pearson相关分析等统计学方法,采用SPSS13.0统计软件包完成有关统计过程。
结果:1.稳定期精神分裂症患者的认知功能受发病年龄、性别、教育程度、药物和精神病理症状的影响。稳定期精神分裂症患者的精神病理症状与社会功能、日常生活能力、疾病家庭负担相关。已婚患者的阴性症状和抑郁症状总分低于未婚患者,男性患者的疾病家庭负担总分高于女性患者。
2.综合组六月末一般病理学量表总分(P＜0.01)和PANSS总分(P＜0.05)显著低于单纯组,TMTB完成时间显著少于单纯组(P＜0.05),社会功能、日常生活能力总分显著低于单纯组(P＜0.05),疾病家庭负担中的家庭成员心理健康分值显著低于单纯组(P＜0.05),生活质量的改善优于单纯组。
3.综合组内,大学组六月末的抑郁症状总分低于高中及以下组(P＜0.05),疾病家庭负担中的家庭日常活动总分低于高中及以下组(P＜0.05)。阿立派唑组阴性症状的改善优于其它三组。
4.稳定期精神分裂症患者PANSS总分、疾病家庭负担总分和负性生活事件值越高,生活质量越差。PANSS一般病理学量表减分率和日常生活能力量表减分率越高,生活质量的改善越显著。
5.奎硫平较常出现嗜睡(X~2=8.687 P＜0.05),利培酮较常出现肌强直(X~2=7.809 P＜0.05),奥氮平较常出现体重增加(X~2=12.370 P＜0.01)。
结论:1.稳定期精神分裂症患者的认知功能受多种因素的影响。
2.婚姻对稳定期精神分裂症患者的精神病理症状有保护作用。
3.稳定期精神分裂症患者的精神病理症状仍是影响社会功能、日常生活能力、疾病家庭负担和生活质量的根本原因。
4.综合治疗对稳定期精神分裂症患者的认知功能、精神病理症状、社会功能、日常生活能力、疾病家庭负担和生活质量均有改善作用。教育程度较高患者的综合治疗效果较好。阿立哌唑有利于综合组阴性症状的改善。
5.四种第二代抗精神病药的副作用存在差异,治疗应根据患者的耐受性不同选择药物。
6.可通过继续本研究的随访,更完整和准确的判断综合治疗的疗效,同时进一步了解稳定期精神分裂症患者长期预后和结局。
Objective:To explore the influencing factors on cognitive function and other clinical characters of stable schizophrenia.Compare the effect of integrated treatment group and control group.The study is aimed to provide corresponding basis for integrated treatment modle which can improve the stable schizophrenia patient's outcome used in our country.
Methods:1.137 outpatients in Shanghai Mental Health Central from July in 2005 to March in 2006,all the patients are cured by only one kind of Second Generation Antipsychotics.There are 29 patients in Risperidone group,44 patients in Zyprexa group,36 patients in Seroquel group,28 patients in Brisking group.2.Every antipsychotics group was randomly divided into control group and integrated treatment group,integrated treatment was additionally combined with bio-psycho-social intervention which included healthy education,social skills training, vocational rehabilitation and psychotherapy.There were 70 patients in control group and 67 patients in integrated treatment group.Integrated treatment group was divided into 4 groups,every group which fixed had 16 or 17 patients,healthy education, social skills training and psychotherapy were carried out one times every month,and vocational rehabilitation was carried out one times every 3 months.All subjects were evaluated using Positive and Negative Syndrome Scale(PANSS),Montgomery and Asberg Depression Rating Scale(MADRS),Treatment Emergent Symptom Scale (TESS),Family Burden Scale(FBS)every 3 months,and Short-Form-36 Health Survey(SF-36),Social Disability Screening Schedule(SDSS),Activity of Daily Living scale(ADL),Life Events Scale(LES)every 6 months.Cognitive function which included Wisconsion Card Sorting Test(WCST),Continuous Performance Test(CPT), Trail Making Test(TMTA and TMTB),Digit Symbol and Digit Span in Wechsler Adult Intelligence Scale Revised in China(WAIS-RC),Visual Reproduction in Wechsler Memory Scale-Revised in China(WMS-RC)was evaluated every 6 months.3.Statistical approaches such as t test,anova analysis,Pearson's x~2 statistics,Stepwise multiple regression analyses,Logistic regression analysis,Pearson correlation analysis were employed to analyze the data according to the characteristic of the distribution of data. The statistical software used throughout the analysis was SPSS13.
Results:1.Cognitive function of stable schizophrenia patients were influenced by age,gender,education level,antipsychotics and psychosis symptom.The patients' psychosis symptom showed significantly correlation with SDSS,ADL and FBS. Married patients' negative and depression symptom's score was significantly higher than un-married patients.2.After 6 months,integrated treatment group's score of PANSS general pathology scale(P＜0.01),PANSS total score(P＜0.05),SDSS (P＜0.05)and ADL'S(P＜0.05)score were significantly lower than control group. Integrated treatment group spent less time to finish the TMTB test than control group (P＜0.01).The score of relative's mental health in FBS is significantly lower than control group(P＜0.05).The improvement of quality life in integrated treatment group was better than control group.3.In integrated treatment group,college group's depression symptom and family daily activity in FBS'S score were lower than high school and below group(P＜0.05).The improvement of negative symptom in Aripiprazole group is better than other groups.4.The higher of PANSS,FBS and LES negative life event's score,the lower of the quality life.The higher of PANSS general pathology and ADL score reduction rate,the better improvement of the quality life.5.The side effect of too much sleep is more frequency on quetiapine(x~2 =8.687 P＜0.05),extrapyramidal side effect is more frequency on risperidone(x~2 =7.809 P＜0.05),weight gain is more frequency on olanzapine(x~2 =12.370 P＜0.01).
Conclusion:1.Cognitive function of stable schizophrenia was influenced by many factors.2.Marriage could protect stable schizophrenia patients' psychosis symptom. 3.Psychosis symptom is the reason of stable schizophrenia patients' lower social function and quality life and higher family burden.4.Integrated treatment would improve stable schizophrenia patients' cognitive function,psychosis symptom,social function,family burden and quality of life better than control group.The effect of integrated treatment for higher education patients is better.Aripiprazole could improve negative symptom in integrated group.5.The side effect of four kinds of second generation antipsychotic is different,so it should be choose by the patients' tolerance.6.Continue this study for a longer time would judge the Integrated treatment more credibly,and explore the stable schizophrenia patients' long term outcome.
引文
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