【摘要】：目的:精神分裂癥是一種進(jìn)行性惡化的慢性精神疾病,致殘、致死及復(fù)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?yàn)樵摬』颊咭话愣既狈Ψ幰缽男?造成了疾病頻繁復(fù)發(fā)、負(fù)擔(dān)加重和生存質(zhì)量嚴(yán)重?fù)p害等不良后果。近年來,運(yùn)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(nèi)觀療法、認(rèn)知治療等均取得一定療效。本研究以DNCT(分散內(nèi)觀認(rèn)知療法)對穩(wěn)定期精神分裂癥患者服藥依從性進(jìn)行干預(yù)研究,以評價(jià)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(qiáng)、作用持續(xù)時(shí)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(biāo)準(zhǔn)和排除標(biāo)準(zhǔn)的60名患者作為研究對象。選用隨機(jī)數(shù)字表法,把患者分為2組,分別為研究組、對照組,每組人數(shù)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(nèi)觀認(rèn)知治療,治療需連續(xù)8周,每天3小時(shí);對照組則在既往藥物治療不變的情況下接受同樣時(shí)間的工娛治療;兩組在治療前、治療后、治療半年后各進(jìn)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(jié)果:60例患者均順利完成研究,進(jìn)入結(jié)果統(tǒng)計(jì)。治療開始前研究組和對照組各項(xiàng)指標(biāo)比較均無統(tǒng)計(jì)學(xué)差異。(1)研究組經(jīng)治療后PANSS總分及各分項(xiàng)與治療前比較明顯降低,有顯著統(tǒng)計(jì)學(xué)差異(P0.01);研究組在治療半年后隨訪發(fā)現(xiàn)除復(fù)合量表以外的,其余各項(xiàng)評分均明顯優(yōu)于治療前,有顯著統(tǒng)計(jì)學(xué)差異(P0.01);治療結(jié)束時(shí)及半年隨訪時(shí)研究組PANSS量表總分及各項(xiàng)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(jì)學(xué)差異(P0.05);研究組半年隨訪時(shí)自知力自評量表評分高于治療前,具有顯著統(tǒng)計(jì)學(xué)差異(P0.01);治療后、半年隨訪時(shí),研究組自知力自評量表評分均較對照組高,有統(tǒng)計(jì)學(xué)差異(P0.05)。(3)研究組治療后及半年隨訪時(shí)ITAQ高于治療前,具有顯著統(tǒng)計(jì)學(xué)差異(P0.01);治療后、半年隨訪時(shí),研究組ITAQ均比對照組高,有統(tǒng)計(jì)學(xué)差異(P0.05)。(4)研究組治療后及半年隨訪時(shí)MARS各因子分值均較治療前升高,有顯著統(tǒng)計(jì)學(xué)差異(P0.01);治療后、半年隨訪時(shí)研究組各因子分值均較對照組高,有統(tǒng)計(jì)學(xué)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(shù)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(jì)學(xué)差異(P0.01)。結(jié)論:(1)在藥物治療的基礎(chǔ)上,使用內(nèi)觀認(rèn)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(chǔ)上,使用內(nèi)觀認(rèn)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(chǔ)上,使用內(nèi)觀認(rèn)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(yīng)的消極態(tài)度;(4)通過治療后半年,進(jìn)行隨訪發(fā)現(xiàn):分散內(nèi)觀認(rèn)知療法的療效在一定時(shí)間范圍內(nèi)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(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R749.3

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