【摘要】：目的:精神分裂癥是一種進行性惡化的慢性精神疾病,致殘、致死及復發(fā)率均高于同類疾病。疾病的治療目前還是以藥物治療為主,但因為該病患者一般都缺乏服藥依從性,造成了疾病頻繁復發(fā)、負擔加重和生存質量嚴重損害等不良后果。近年來,運用心理治療改善該癥患者的服藥依從性愈發(fā)得到重視,內觀療法、認知治療等均取得一定療效。本研究以DNCT(分散內觀認知療法)對穩(wěn)定期精神分裂癥患者服藥依從性進行干預研究,以評價其臨床療效,為改善穩(wěn)定期精神分裂癥患者服藥依從性的治療探索一種可操作性強、作用持續(xù)時間長且副作用小的方法。方法:將2016年1月至4月在天津市安康醫(yī)院住院,符合入組標準和排除標準的60名患者作為研究對象。選用隨機數字表法,把患者分為2組,分別為研究組、對照組,每組人數各占1/2;研究組在既往藥物治療不變的情況下合并分散內觀認知治療,治療需連續(xù)8周,每天3小時;對照組則在既往藥物治療不變的情況下接受同樣時間的工娛治療;兩組在治療前、治療后、治療半年后各進行一次PANSS(陽性與陰性癥狀量表)、ITAQ(自知力與治療態(tài)度問卷)、自知力自評量表、服藥依從性量表、MARS(藥物依從性量表)的評定。結果:60例患者均順利完成研究,進入結果統(tǒng)計。治療開始前研究組和對照組各項指標比較均無統(tǒng)計學差異。(1)研究組經治療后PANSS總分及各分項與治療前比較明顯降低,有顯著統(tǒng)計學差異(P0.01);研究組在治療半年后隨訪發(fā)現除復合量表以外的,其余各項評分均明顯優(yōu)于治療前,有顯著統(tǒng)計學差異(P0.01);治療結束時及半年隨訪時研究組PANSS量表總分及各項評分均較對照組降低。(2)研究組治療后自知力自評量表評分較治療前升高,有統(tǒng)計學差異(P0.05);研究組半年隨訪時自知力自評量表評分高于治療前,具有顯著統(tǒng)計學差異(P0.01);治療后、半年隨訪時,研究組自知力自評量表評分均較對照組高,有統(tǒng)計學差異(P0.05)。(3)研究組治療后及半年隨訪時ITAQ高于治療前,具有顯著統(tǒng)計學差異(P0.01);治療后、半年隨訪時,研究組ITAQ均比對照組高,有統(tǒng)計學差異(P0.05)。(4)研究組治療后及半年隨訪時MARS各因子分值均較治療前升高,有顯著統(tǒng)計學差異(P0.01);治療后、半年隨訪時研究組各因子分值均較對照組高,有統(tǒng)計學差異(P0.01或P0.05);(5)治療后研究組服藥依從性量表中“治療依從”的例數明顯增加,所占比例增加了46%,對照組增加了7%,有顯著統(tǒng)計學差異(P0.01)。結論:(1)在藥物治療的基礎上,使用內觀認知療法,可以改善精神分裂癥穩(wěn)定期患者的各種精神癥狀,陰性癥狀及占優(yōu)勢的綜合征改善尤為明顯;(2)在藥物治療的基礎上,使用內觀認知療法,可以明顯改善精神分裂癥穩(wěn)定期患者的自知力;(3)在藥物治療的基礎上,使用內觀認知療法,可以提高精神分裂癥穩(wěn)定期患者服藥依從性,明顯改善對精神藥物副反應的消極態(tài)度;(4)通過治療后半年,進行隨訪發(fā)現:分散內觀認知療法的療效在一定時間范圍內能夠保持較好效果。
[Abstract]:Objective: Schizophrenia is a kind of progressive deterioration of chronic mental illness, disability, death and recurrence rate are higher than that of the same kind of disease. The treatment of disease is still mainly drug therapy, but because the patient is generally lack of medication compliance, it causes frequent recurrence of disease, severe burden and serious damage to the quality of life. In recent years, the use of psychotherapy to improve the compliance of patients with this disease has gained more attention, internal view therapy, cognitive therapy and so on. In this study, the compliance of patients with stable schizophrenia treated with DNCT (internal cognitive therapy) was studied in order to evaluate its clinical efficacy, and to explore an effective way to improve the compliance of patients with schizophrenia in stable period. a method of long duration and small side effects. Methods: Sixty patients who were hospitalized in Ankang Hospital of Tianjin from January to April 2016 were enrolled as research subjects. The patients were randomly divided into two groups: study group and control group, each group was 1/ 2; The control group was treated with the same time as the previous drug therapy; two groups were treated before and after treatment, each time after six months of treatment, the PANSS (positive and negative symptom scale), ITAQ (positive and treatment attitude questionnaire) and self-rating scale self-rating scale were performed. Evaluation of drug compliance scale, MARS (drug compliance scale). Results: All 60 patients successfully completed the study and entered the results statistics. There was no statistical difference in the indices of the study group and the control group before treatment. (1) After treatment, the total score of PANSS and the scores of each sub-item were significantly lower than that before treatment (P <0.01). The total scores and scores of PANSS were lower in the study group at the end of treatment and half-year follow-up. (2) The self-rating scale score was higher in the study group than before the treatment (P0.05). The scores of self-rating scale were higher in the study group than in the control group (P <0.05). (3) Compared with the control group, the ITAQ of the study group was higher than that of the control group (P0.05). (4) After treatment and half-year follow-up, the scores of all factors of MARS increased significantly before treatment (P <0.01), and the scores of each factor in the study group were higher than those in the control group at half-year follow-up, and there was statistical difference (P 0.01 or P 0.05). (5) Drug compliance scale of study group after treatment "Treatment compliance" The number of cases increased significantly, the proportion increased by 46%, the control group increased by 7%, there was significant statistical difference (P0.01). Conclusion: (1) On the basis of drug therapy, we can improve the mental symptoms, negative symptoms and the improvement of syndrome in stable patients with schizophrenia by using internal cognitive therapy. (2) On the basis of drug therapy, we use internal cognitive therapy. (3) using internal view cognitive therapy on the basis of drug therapy to improve the compliance of drug administration in patients with schizophrenia and improve the negative attitude to side reaction of psychotropic substances; (4) After six months of treatment, the follow-up findings show that the therapeutic effect of the cognitive therapy in dispersion can keep better effect over a certain period of time.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R749.3

【參考文獻】

相關期刊論文 前10條

1 毛富強;;內觀認知療法理論與操作[J];中華行為醫(yī)學與腦科學雜志;2016年07期

2 潘江艷;韋鑫;楊盼;;精神分裂癥患者服藥依從性研究進展[J];中外醫(yī)學研究;2016年20期

3 閔國慶;;精神分裂癥患者臨床服藥依從性的影響因素與管理對策[J];中醫(yī)藥管理雜志;2015年22期

4 屈金蓮;張濤;宋杰;房海英;;出院后精神分裂癥患者服藥依從性電話和短信干預的1年隨訪[J];中國心理衛(wèi)生雜志;2015年09期

5 吳越;張恒;樊瑩瑩;張紫娟;陸鑫曉;沈文嫻;;積極性社區(qū)干預治療精神分裂癥患者的成本-效果分析[J];中國全科醫(yī)學;2014年32期

6 賀建軍;黃宣銀;;精神分裂癥患者服藥依從性的研究進展[J];四川精神衛(wèi)生;2014年05期

7 茅榮杰;朱光;羅碧明;黃樂萍;介勇;史泊海;汪作為;;內觀療法與行為療法對精神分裂癥患者近期服藥依從性的影響[J];臨床精神醫(yī)學雜志;2014年04期

8 程娟;徐小童;毛富強;劉霞;曹桐;杜建艷;馬宏筠;;內觀認知療法改善偏執(zhí)型精神分裂癥康復期社會功能的研究[J];天津醫(yī)科大學學報;2014年04期

9 孫莉;謝紅濤;王祖承;;抗精神病藥物主觀耐受性障礙和服藥依從性研究現狀分析[J];藥物流行病學雜志;2014年07期

10 黃源;劉國恩;劉躍華;王長之;任曉曉;張慧;;精神分裂癥的疾病經濟負擔:基于廣州醫(yī)保數據的分析[J];中國衛(wèi)生經濟;2014年05期

相關碩士學位論文 前5條

1 何汶潼;醫(yī)學生進食障礙危險因素調查分析及內觀認知療法研究[D];天津醫(yī)科大學;2015年

2 張曉菲;醫(yī)學生網絡成癮障礙內觀認知療法干預研究[D];天津醫(yī)科大學;2013年

3 曲鴻儒;偏執(zhí)型精神分裂癥康復期男性患者認知功能損害分散內觀認知療法干預對照研究[D];天津醫(yī)科大學;2012年

4 侯筱菲;內觀認知療法對抑郁癥患者認知偏差干預研究[D];天津醫(yī)科大學;2012年

5 高艷杰;偏執(zhí)型精神分裂癥康復期患者分散內觀認知療法干預研究[D];天津醫(yī)科大學;2011年

，

本文編號：2266028