住院精神分裂癥患者整合治療模式的建立與療效評估
發(fā)布時間：2018-07-17 06:16
【摘要】：研究背景:精神分裂癥是一組病因未明的重性精神疾病,具有高發(fā)病率和高致殘率的特點,為自身,家庭及社會帶來沉重負擔。雖然藥物治療一直是精神分裂癥治療的基石,卻有其局限性。研究表明,大部分精神分裂癥患者需要長期服藥治療,同時也要面對各種藥物副作用,依從性差,復發(fā)風險高,社會功能難改善等問題。而聯(lián)合使用心理治療、家庭教育及認知行為療法等社會心理學干預手段,對于增加精神分裂癥患者的服藥依從性、提高生活質(zhì)量、改善社會功能方面具有較大幫助,這彌補了單純藥物治療的不足。然而,社會心理學干預治療目前僅在我國大城市的精神�？朴兴_展,且多針對門診或慢性患者,因時間、空間所限,傳統(tǒng)的長療程社會心理學干預治療難以在我國精神分裂癥患者中普及,這限制了我國精神分裂癥患者長期治療的有效性。研究目的:本研究嘗試利用藥物治療結合認知行為治療和康復治療技術及臨床個案管理,建立一套新的“強化-鞏固”整合治療模式,并從精神癥狀,治療依從性,復發(fā)率,和社會功能四個方面評估該治療模式的有效性,為探討適用于我國精神分裂癥住院患者的治療新模式提供思路及實證基礎。研究方法:研究對象為2012年至2015年,在廣州醫(yī)科大學附屬腦科醫(yī)院的精神科住院的170名精神分裂癥患者,并隨機分配為整合治療組(86名)和單純藥物治療組(84名)。對這些患者進行一般人口學資料收集,陽性陰性癥狀量表(Positive and negative syndrome scale,PANSS)、臨床療效總評量表(Clinical Global Impression Scale,CGI-S)及個人與社會功能量表(Personal and social perforance scale,PSP)評定,并以此作為基線數(shù)據(jù)。單純藥物治療組患者僅使用抗精神病藥物治療,整合治療組患者除使用抗精神病藥物外,還給予認知行為治療和康復治療及全程臨床個案管理。認知行為療法全程共有20次治療。認知行為治療分為強化治療階段和鞏固治療階段。強化治療階段按照每周1-2次的頻率,在12周內(nèi)共實施17次治療,每次時間約45分鐘。鞏固治療階段則在入組后第6個月、第9個月和第12個月,分別進行一次治療,每次時間約45分鐘。康復治療全程共15次治療,包括三個方面的內(nèi)容:用藥管理、癥狀管理和社會技能訓�？祻椭委熞喾譃閺娀委熾A段和鞏固治療階段。強化治療階段按照每周1-2次的頻率,共進行12治療,每次時間約120分鐘。鞏固治療階段則在入組后在第3個月、第6個月和第9個月,分別予以1次治療,每次時間約120分鐘。對所有患者在入組后的第3個月、第6個月、第12個月,分別進行一次隨訪,并對其進行PANSS、CGI-S、PSP量表評定。治療效果的評估包括精神癥狀,依從性,復發(fā)率,和社會功能四個方面。所有數(shù)據(jù)采用SPSS20.0軟件進行統(tǒng)計分析。根據(jù)資料類型的不同采用了獨立樣本t檢驗、皮爾森卡方(χ2)檢驗和費舍爾精確檢驗來比較兩組病人的基線特征。治療后PANSS、CGI和PSP量得分的變化分析采用重復測量資料的混合效應模型分析(Mixed Effects Model for Repeated-Measures analyses,MMRM)。分析治療因素、時間因素以及時間與治療因素的交互效應時,通過對基線得分采用非限制性的協(xié)方差分析來檢驗。評估時間點分別為基線期,入組后第3、第6和第12個月。檢驗水準為α=0.05。研究結果:1.人口學資料統(tǒng)計:共118例(69.4%)患者完成12個月隨訪。整合治療組隨訪12個月的完成率顯著高于單純藥物治療組(p0.05)。兩組的年齡,性別,受教育程度,發(fā)病年齡及病程均無顯著差異(P0.05)。2.PANSS、CGI-S、PSP評分:在基線期,整合治療組患者的PANSS一般精神病理量表分,個人和社會關系得分均顯著高于單純藥物治療組(P0.05)。在入組后第12個月,兩組患者的PANSS總分,CGI-S得分均較基線期顯著下降(p0.001)、PSP總分均較基線期顯著提高(p0.001)。在入組后第6個月,整合治療組的PANSS總分、PANSS陽性量表分、PANSS一般精神病理量表分及CGI-S得分均顯著低于單純藥物治療組(p0.05)。在入組后第3個月,整合治療組PSP量表的自我照料得分,和擾亂及攻擊行為得分均顯著低于單純藥物治療組(p0.05)。3.復發(fā)率評估:整合治療組隨訪12個月內(nèi)復發(fā)率顯著低于單純藥物治療組(p0.05)。整合治療組隨訪12個月內(nèi)的再次住院率及平均住院次數(shù)均顯著低于單純藥物治療組(p0.05)。4.治療依從性評估:兩組隨訪12個月內(nèi)總的藥物不依從率為38.2%。整合治療組的不依從率顯著低于單純藥物治療組(p0.001)。研究結論:1.精神分裂癥的整合治療模式與單純藥物治療模式相比,能更好地改善患者的精神癥狀,提高依從性,降低臨床復發(fā)率,和改善社會功能。2.精神分裂癥的整合治療模式與單純藥物治療模式相比,能更早地改善患者的社會功能。
[Abstract]:Background: schizophrenia is a group of unidentified heavy mental diseases with a high incidence and high disability rate, which brings a heavy burden to itself, family and society. Although drug treatment has been the cornerstone of the treatment of schizophrenia, it has its limitations. The study shows that most schizophrenic patients need long-term medication treatment. At the same time, we should also face the problems of adverse drug side effects, poor compliance, high recurrence risk, and social function difficult to improve. And social psychological intervention, such as psychotherapy, family education and cognitive behavioral therapy, should be used to improve the quality of life and social function of patients with schizophrenia. It helps to make up for the deficiency of pure drug treatment. However, social psychological intervention therapy is currently only carried out in the psychiatric specialist of large cities in our country, and more targeted to outpatient or chronic patients. Due to time and space, the traditional long course of social psychological intervention is difficult to popularize in the schizophrenic patients in our country. The purpose of this study is to establish a new "strengthening consolidation" integrated treatment model with four aspects of mental symptoms, treatment compliance, recurrence rate and social function. The effectiveness of the treatment model was estimated to provide an idea and an empirical basis for exploring the new mode of treatment for schizophrenic inpatients in China. The study was conducted from 2012 to 2015 at the psychiatric department of the Guangzhou Medical University, affiliated to the Guangzhou Medical University, which was randomly assigned to an integrated treatment group (86 The general demographic data collection, the positive negative symptom checklist (Positive and negative syndrome scale, PANSS), the total clinical efficacy scale (Clinical Global Impression Scale, CGI-S), and the individual and social functional scale (Personal) were evaluated for these patients. They were used as baseline data. The patients in the simple drug treatment group were treated with antipsychotic drugs only. The patients in the integrated treatment group were given cognitive behavioral therapy and rehabilitation treatment as well as the whole course of clinical case management. Cognitive behavior therapy was divided into 20 treatments. Cognitive behavior therapy was divided into intensive treatment stage, and cognitive behavioral therapy. Strengthening the treatment stage. The intensive treatment stage, according to the frequency of 1-2 times a week, was performed 17 times within 12 weeks, each time of about 45 minutes. The consolidation treatment stage was sixth months, Ninth months and twelfth months after entering the group, with a time of about 45 minutes each time. The whole course of rehabilitation was treated in a total of 15 times, including three aspects. Medication management, symptom management and social skills training. Rehabilitation therapy is also divided into intensive treatment stage and consolidation treatment stage. The intensive treatment stage, according to the frequency of 1-2 times a week, is treated with 12 treatments, each time is about 120 minutes. The consolidation treatment stage is treated in third months, sixth months and ninth months after entering the group, and each time is treated with 1 times, each time. An interval of about 120 minutes. All patients were followed up for third months, sixth months and twelfth months after entering the group. The PANSS, CGI-S, and PSP scales were evaluated. The evaluation of the therapeutic effect included four aspects of mental symptoms, compliance, recurrence, and social function. All data were analyzed by SPSS20.0 software. Independent sample t test was used in different types. Pearson chi square (chi square) test and Fisher accurate test were used to compare the baseline characteristics of the two groups. The changes in the PANSS, CGI, and PSP scores after treatment were analyzed by the mixed effect model analysis (Mixed Effects Model for Repeated-Measures analyses, MMRM). Treatment factors, time factors and interaction effects of time and treatment factors were tested by non restrictive covariance analysis on baseline scores. The time points were evaluated at baseline, third, sixth, and twelfth months after entering the group. The test level was alpha =0.05. results: 1. oral data statistics: 118 cases (69.4%) completed 12 months. The completion rate of the integrated treatment group was significantly higher than that of the drug treatment group (P0.05). The age, sex, education, age and course of disease were not significantly different in the two groups (P0.05).2.PANSS, CGI-S, and PSP score: at the baseline, the general psychopathological score of the PANSS in the integrated treatment group, and the scores of personal and social relationships were all Twelfth months after entering the group, the total score of PANSS was significantly lower than the baseline (p0.001), and the total score of PSP was significantly higher than the baseline (p0.001) in the twelfth months after entering the group. The total PANSS score, the PANSS positive scale, and the PANSS general psychopathology scale and CGI-S in the integrated treatment group were sixth months after the entry of the group. The scores were significantly lower than that of the simple drug treatment group (P0.05). The self care score of the PSP scale in the integrated treatment group and the score of disturbance and attack behavior were significantly lower than that of the simple drug treatment group (P0.05).3. recurrence rate in the third months after the entry group: the recurrence rate in the integrated treatment group was significantly lower than that of the simple drug treatment group (P0.05). The rate of rehospitalization and average hospitalization in the treatment group were significantly lower than that in the treatment group (P0.05).4. treatment compliance assessment within 12 months of follow-up. The total drug failure rate in the two group was significantly lower than that of the drug treatment group (p0.001) in the 38.2%. integration group within 12 months of follow-up. Compared with the simple drug treatment model, the combined treatment model can better improve the patient's mental symptoms, improve the compliance, reduce the rate of clinical recurrence, and improve the integrated treatment mode of social function.2. schizophrenia and the simple drug treatment model, and can improve the social function of the patients earlier.
【學位授予單位】：廣州醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R749.3
本文編號：2129361
[Abstract]:Background: schizophrenia is a group of unidentified heavy mental diseases with a high incidence and high disability rate, which brings a heavy burden to itself, family and society. Although drug treatment has been the cornerstone of the treatment of schizophrenia, it has its limitations. The study shows that most schizophrenic patients need long-term medication treatment. At the same time, we should also face the problems of adverse drug side effects, poor compliance, high recurrence risk, and social function difficult to improve. And social psychological intervention, such as psychotherapy, family education and cognitive behavioral therapy, should be used to improve the quality of life and social function of patients with schizophrenia. It helps to make up for the deficiency of pure drug treatment. However, social psychological intervention therapy is currently only carried out in the psychiatric specialist of large cities in our country, and more targeted to outpatient or chronic patients. Due to time and space, the traditional long course of social psychological intervention is difficult to popularize in the schizophrenic patients in our country. The purpose of this study is to establish a new "strengthening consolidation" integrated treatment model with four aspects of mental symptoms, treatment compliance, recurrence rate and social function. The effectiveness of the treatment model was estimated to provide an idea and an empirical basis for exploring the new mode of treatment for schizophrenic inpatients in China. The study was conducted from 2012 to 2015 at the psychiatric department of the Guangzhou Medical University, affiliated to the Guangzhou Medical University, which was randomly assigned to an integrated treatment group (86 The general demographic data collection, the positive negative symptom checklist (Positive and negative syndrome scale, PANSS), the total clinical efficacy scale (Clinical Global Impression Scale, CGI-S), and the individual and social functional scale (Personal) were evaluated for these patients. They were used as baseline data. The patients in the simple drug treatment group were treated with antipsychotic drugs only. The patients in the integrated treatment group were given cognitive behavioral therapy and rehabilitation treatment as well as the whole course of clinical case management. Cognitive behavior therapy was divided into 20 treatments. Cognitive behavior therapy was divided into intensive treatment stage, and cognitive behavioral therapy. Strengthening the treatment stage. The intensive treatment stage, according to the frequency of 1-2 times a week, was performed 17 times within 12 weeks, each time of about 45 minutes. The consolidation treatment stage was sixth months, Ninth months and twelfth months after entering the group, with a time of about 45 minutes each time. The whole course of rehabilitation was treated in a total of 15 times, including three aspects. Medication management, symptom management and social skills training. Rehabilitation therapy is also divided into intensive treatment stage and consolidation treatment stage. The intensive treatment stage, according to the frequency of 1-2 times a week, is treated with 12 treatments, each time is about 120 minutes. The consolidation treatment stage is treated in third months, sixth months and ninth months after entering the group, and each time is treated with 1 times, each time. An interval of about 120 minutes. All patients were followed up for third months, sixth months and twelfth months after entering the group. The PANSS, CGI-S, and PSP scales were evaluated. The evaluation of the therapeutic effect included four aspects of mental symptoms, compliance, recurrence, and social function. All data were analyzed by SPSS20.0 software. Independent sample t test was used in different types. Pearson chi square (chi square) test and Fisher accurate test were used to compare the baseline characteristics of the two groups. The changes in the PANSS, CGI, and PSP scores after treatment were analyzed by the mixed effect model analysis (Mixed Effects Model for Repeated-Measures analyses, MMRM). Treatment factors, time factors and interaction effects of time and treatment factors were tested by non restrictive covariance analysis on baseline scores. The time points were evaluated at baseline, third, sixth, and twelfth months after entering the group. The test level was alpha =0.05. results: 1. oral data statistics: 118 cases (69.4%) completed 12 months. The completion rate of the integrated treatment group was significantly higher than that of the drug treatment group (P0.05). The age, sex, education, age and course of disease were not significantly different in the two groups (P0.05).2.PANSS, CGI-S, and PSP score: at the baseline, the general psychopathological score of the PANSS in the integrated treatment group, and the scores of personal and social relationships were all Twelfth months after entering the group, the total score of PANSS was significantly lower than the baseline (p0.001), and the total score of PSP was significantly higher than the baseline (p0.001) in the twelfth months after entering the group. The total PANSS score, the PANSS positive scale, and the PANSS general psychopathology scale and CGI-S in the integrated treatment group were sixth months after the entry of the group. The scores were significantly lower than that of the simple drug treatment group (P0.05). The self care score of the PSP scale in the integrated treatment group and the score of disturbance and attack behavior were significantly lower than that of the simple drug treatment group (P0.05).3. recurrence rate in the third months after the entry group: the recurrence rate in the integrated treatment group was significantly lower than that of the simple drug treatment group (P0.05). The rate of rehospitalization and average hospitalization in the treatment group were significantly lower than that in the treatment group (P0.05).4. treatment compliance assessment within 12 months of follow-up. The total drug failure rate in the two group was significantly lower than that of the drug treatment group (p0.001) in the 38.2%. integration group within 12 months of follow-up. Compared with the simple drug treatment model, the combined treatment model can better improve the patient's mental symptoms, improve the compliance, reduce the rate of clinical recurrence, and improve the integrated treatment mode of social function.2. schizophrenia and the simple drug treatment model, and can improve the social function of the patients earlier.
【學位授予單位】：廣州醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R749.3
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