家庭干预联合药物自我管理技能训练治疗精神分裂症的疗效

目的 探讨家庭干预联合药物自我管理技能训练治疗精神分裂症的效果.方法 160例精神分裂症患者随机分为观察组和对照组各80例,对照组接受常规治疗,观察组在此基础上给予家庭干预联合药物自我管理技能训练,观察2组简明精神病量表(BPRS)、社会功能缺陷筛选量表(SDSS)、生存质量测量量表(BREF)、阳性症状评定量表(SAPS)和阴性症状评定量表(SANS)评分.结果 2组治疗前各项评分差异均无统计学意义(P＞0.05),治疗6个月与治疗前比较,均明显下降,差异有统计学意义(P＜0.05);观察组优于对照组,差异有统计学意义(P＜0.05).结论 家庭干预联合药物自我管理技能训练提高了治疗依从性,改善了病情、社会功能及生活质量,精神分裂症阳性和阴性症状也明显降低.     

计算机认知矫正治疗联合社交技能训练对精神分裂症患者认知功能的疗效

目的 探讨计算机认知矫正治疗联合社交技能训练改善精神分裂症患者认知功能的效 果。方法 2017 年1—12 月选取168 例慢性精神分裂症患者随机分为干预组（入组82 例，完成79 例）和 对照组（入组86 例，完成84 例），分别接受12 周的计算机认知矫正治疗联合社交技能训练和计算机认知 矫正治疗12周，并随访12个月。采用阳性与阴性症状量表（PANSS）、精神分裂症认知功能成套测验中文 版（MCCB）及个人和社会功能量表（PSP）在基线、12周末及随访12个月末分别进行评估。结果 （1）治疗 12周末，干预组PANSS的认知因子分明显低于对照组（t=-4.22，P＜0.001）；随访12个月末时干预组的阴性 因子分及认知因子分均明显低于对照组（t=-2.36，P=0.020；t=-5.91，P＜0.001）。随访12个月末，干预组的 PANSS总分与基线比较差异有统计学意义（t=3.41，P＜0.001），但与对照组比较差异无统计学意义（t=1.57， P=0.119）。（2）干预组在12个月末的PSP总分、神经认知功能总分和社会认知分均高于对照组，两组比较 差异均有统计学意义（P＜0.05）。结论 计算机认知矫正治疗联合社交技能训练能够显著改善精神分裂 症患者的认知功能，从而有效促进社会功能恢复。     

激励机制对长期住院精神分裂症患者阴性症状的影响

目的 探讨激励机制对慢性精神分裂症长期住院患者阴性症状的影响.方法 选择100例慢性精神分裂症住院患者随机分为研究组和对照组,每组50例;在维持原治疗和护理的同时对研究组患者实施为期12周的激励护理干预措施;在实施激励措施前及实施激励措施后第4、12周末分别用阴性症状量表(SANS)和护士用住院观察量表(NOSIE-30)进行疗效评定.结果 两组患者在实施激励措施前SANS、NOSIE-30评分间差异无显著性意义(P均>0.05);实施激励措施前后研究组患者的SANS、NOSIE-30各评分间差异均存在显著性意义(P<0.05),而对照组患者的SANS、NOSIE-30各评分间差异仍无显著性意义(P>0.05).结论 激励可改善慢性精神分裂症长期住院患者的阴性症状,同时提高患者生活质量.     

康复训练对女性慢性精神分裂症患者疗效观察

目的探讨康复训练对女性慢性精神分裂症患者的疗效。方法将52例女性慢性精神分裂症患者分为研究组和对照组,在常规药物治疗的基础上,对研究组病人进行12周的康复训练,对照组采用传统的医疗模式,分别于研究前,研究12周后运用阳性和阴性症状量表(PANSS)和生活质量综合评定问卷(GQOLI-74)进行评定。结果训练前2组各量表评分差异均无显著性(P>0.05),训练后研究组PANSS阴性因子分,一般精神病理量表分,总分较训练前明显下降(P<0.01)。研究组的生活质量综合评定问卷总分及各维度评分均高于对照组(P<0.01)。结论康复训练可改善女性慢性精神分裂症患者的临床症状和生活质量。     

团体社会技能康复训练对慢性精神分裂症长期住院患者疗效

目的:探讨基于本地文化的团体社会技能康复训练对慢性精神分裂症长期住院患者疗效。方法:选取海宁市第四人民医院精神科2020年1月至2022年2月收治的80例慢性精神分裂症长期住院患者,按随机数字表法分为研究组40例和对照组40例,研究组常规治疗基础上加上基于本地文化的团体社会技能康复训练,对照组给予常规治疗;治疗前和治疗3个月后应用阴性症状评定量表(SANS)、阳性症状评定量表(SAPS)评定疗效,并检测血清白介素-6(IL-6)水平。结果:研究组和对照组干预前SANS、SAPS评分比较,差异均无统计学意义(P均>0.05);研究组干预前后SANS评分的差值比对照组更大,两组差异有统计学意义(P<0.01),团体社会技能康复训练对阴性症状有中等度效应;研究组干预前后IL-6水平差值和SANS差值、IL-6水平差值和SAPS差值均存在显著相关性,而对照组无相关性。结论:慢性精神分裂症长期住院患者采用团体社会技能康复训练可改善阴性症状,精神分裂症患者可能存在血清白介素-6水平异常。     

程式化技能训练对社区精神分裂症患者康复效果的1年随访

目的:探讨程式化技能训练对社区精神分裂症患者的康复效果。方法:以社区精神分裂症患者180例为研究对象,随机分成对照组92例和干预组88例,由居委会工作人员为干预组进行程式技能训练6个月,采用简明精神病量表(BPRS)、自知力与治疗态度问卷(ITAQ)、个人与社会表现量表(PSP),并统计复发率,评估训练前后对照组和干预组的康复效果差异。并且在结束1个月后把干预组88例再分成新的对照组48例和干预组40例,进行重复的程式训练以及量表评分,比较重复干预后的两组康复情况差异。结果:与对照组相比,第1次程式训练后,干预组的BPRS总分明显下降(F=16.78),ITAQ评分提高(F=27.26),PSP评分提高(F=27.58);经过第2次重复程式训练后,干预组各量表分与对照组相比差异仍有统计学意义,BPRS总分进一步下降(F=4.02),ITAQ评分提高(F=5.88),PSP评分提高(F=4.64)。两次干预都结束时,对照组复发率(11.8%)要高于干预组(8.2%),但差异无统计学意义(P0.05)。结论:经过程式技能训练后,患者的精神症状能有显著的缓解,并且自知力得以提高,社会功能改善。     

精神分裂症患者面孔情绪认知特点及其影响因素研究

目的探讨精神分裂症患者面孔情绪认知的特点及其影响因素。方法采用中国人面孔情绪测验(CFET)对121例精神分裂症患者进行测试,与76名正常对照比较,同时作阳性症状量表(SAPS)和阴性症状量表(SANS)评定。结果患者组6种基本情绪认知正确数均显著低于对照组,远隔错误数均显著高于对照组。回归分析显示,患者情绪认知障碍与年龄、用药情况、病程、住院次数及SAPS和SANS总评分无关,而受教育年限与情绪认知正确数和远隔错误数评分及多项不同情绪认知评分相关。SAPS阳性思维形式障碍因子分与CFET正确数总分呈负相关,而与CFET远隔错误数总分呈正相关,同时与惊、悲、怒情绪认知评分呈相关。SANS的注意障碍因子分与CFET正确数总分呈负相关,而与CFET远隔错误数总分呈正相关。结论精神分裂症患者存在广泛的情绪认知障碍并与某些症状相关,提示情绪认知障碍可能与疾病病理生理过程有关。     

丁螺环酮辅助治疗慢性精神分裂症患者阴性症状的对照研究

目的:观察丁螺环酮辅助治疗慢性精神分裂症阴性症状的疗效及安全性。方法:将60例以阴性症状为主的慢性精神分裂症患者随机分为两组,在原抗精神病药基础上,分别联用丁螺环酮或安慰剂,疗程12周。在治疗前和治疗第4、8、12周末采用阳性和阴性症状量表(PANSS)及阴性症状量表(SANS)评估疗效,治疗中出现的症状量表(TESS)评估安全性。结果:研究组PANSS阴性因子总分、阴性因子各项症状分(除抽象思维困难和刻板思维)及SANS总分、各项分量表综合评价总分、分量表综合评价分(除思维贫乏)均在第12周末显著低于对照组(P0.05或P0.01);PANSS阴性因子总分、阴性因子各项症状分及SANS总分、各项分量表综合评价总分、分量表综合评价分从第8周末开始显著低于治疗前(P0.05或P0.01)。两组间不良反应差异无统计学意义(P0.05)。结论:联用丁螺环酮对治疗慢性精神分裂症阴性症状有增效作用,安全性好。     

艾司西酞普兰对慢性精神分裂症阴性症状的作用

目的:观察艾司西酞普兰对慢性精神分裂症阴性症状的作用. 方法:以阴性症状为主的83例慢性精神分裂症患者随机分为研究组和对照组;两组在原有抗精神病药物的基础上,研究组加用艾司西酞普兰10～ 20 mg/d,共12周.于治疗前后分别进行阴性症状量表(SANS)、治疗中出现的症状量表(TESS)和洛文斯顿作业疗法用认知功能评定成套测验(LOTCA). 结果:12周后,研究组SANS总分及情感平淡、意志缺乏、兴趣缺乏评分明显低于对照组(P ＜0.05 ～0.01);LOTCA评分显著高于治疗前及对照组(t=-10.45,P=0.000;t =2.17,P=0.033);药物不良发生率两组间差异无统计学意义.结论:艾司西酞普兰对慢性精神分裂症阴性症状及认知功能有一定改善作用,不良反应轻微.     

氯氮平,舒必利对首发精神分裂症阴性症状群疗效对照研究

目的 了解氯氮平、舒必利对精神分裂症阴性症状群的疗效及副反应。 方法 采用前瞻性单盲对照研究方法,以阴性症状量表(SANS)的得分结果评价。结果 两组在治疗前后SANS总分及各分量表的综合评分均显著降低(P<0.05或P<0.01)。舒必利组在兴趣社交缺乏方面效优于氯氮平(P<0.05)。两药的副反应种类不同,总的发生率氯氮平高于舒必利。     

社交技能训练对精神分裂症患者社会功能的影响

目的：探讨社交技能训练对精神分裂症缓解期患者社会功能的影响。方法：将95例缓解期患者随机分为干预组和对照组。对干预组给予小组社交技能训练，于干预前及干预12个月后采用社会功能缺陷筛选表（SDSS）、家庭负担量表（FBS）进行评定。结果：干预组训练前后的SDSS评分及FBS中家庭日常活动、家庭关系等差异均有显著性（P均〈0．05），对照组在治疗前后差异无显著性。结论：在药物治疗的基础上，系统而规则的社交技能训练能有效地改善患者处理家庭关系和家庭日常活动的能力并促进患者的社会功能恢复。     

社区监管和药物自我处置程序化训练对首发分裂症康复的经济效益研究

目的探讨社区监管和药物自我处置程序化训练对首发分裂症康复效果的经济效益。方法对纳入社区管理的首发分裂症患者,随机分为干预组48例和对照组50例,并进行为期18个月的追踪随访,采用简明精神病评定量表(BPRS)、社会功能缺陷筛选量表(SDSS)及自编调查表评定。结果两组比较,干预组的患者精神症状较稳定,后续住院费用较省,工作收入较多。结论在社区监管的基础上开展药物自我处置程序化训练能更好地改善首发分裂症患者的精神症状和社会功能,降低后续住院医疗费用,可作为首发分裂症患者有效的康复措施之一。     

A randomized, controlled trial of cognitive behavioral social skills training for middle-aged and older outpatients with chronic schizophrenia

OBJECTIVE: The number of older patients with chronic schizophrenia is increasing. There is a need for empirically validated psychotherapy interventions for these patients. Cognitive behavioral social skills training teaches cognitive and behavioral coping techniques, social functioning skills, problem solving, and compensatory aids for neurocognitive impairments. The authors compared treatment as usual with the combination of treatment as usual plus cognitive behavioral social skills training. METHOD: The randomized, controlled trial included 76 middle-aged and older outpatients with chronic schizophrenia, who were assigned to either treatment as usual or combined treatment. Cognitive behavioral social skills training was administered over 24 weekly group sessions. Blind raters assessed social functioning, psychotic and depressive symptoms, cognitive insight, and skill mastery. RESULTS: After treatment, the patients receiving combined treatment performed social functioning activities significantly more frequently than the patients in treatment as usual, although general skill at social functioning activities did not differ significantly. Patients receiving cognitive behavioral social skills training achieved significantly greater cognitive insight, indicating more objectivity in reappraising psychotic symptoms, and demonstrated greater skill mastery. The overall group effect was not significant for symptoms, but the greater increase in cognitive insight with combined treatment was significantly correlated with greater reduction in positive symptoms. CONCLUSIONS: With cognitive behavioral social skills training, middle-aged and older outpatients with chronic schizophrenia learned coping skills, evaluated anomalous experiences with more objectivity (achieved greater cognitive insight), and improved social functioning. Additional research is needed to determine whether cognitive insight mediates psychotic symptom change in cognitive behavior therapy for psychosis.     

Symptoms and neurocognition as rate limiters in skills training for psychotic patients.

OBJECTIVE: This study aimed to replicate findings that neurocognitive capacity in schizophrenia is more predictive of acquisition of social skills than are symptoms. METHOD: Thirty-two hospitalized patients with chronic psychotic disorders were randomly assigned to community reintegration skills training or supportive group therapy. Neurocognitive functioning was assessed before treatment, and symptoms and skill levels were measured before and after treatment. RESULTS: The skills training group showed significantly greater skill acquisition. In a regression model, skill acquisition was predicted by group membership and verbal memory capacity and not by symptoms. CONCLUSIONS: With methodological advances, the authors replicated findings regarding the importance of neurocognition in determining treatment outcome in schizophrenia.     

Effects of new cognitive-behavioral therapy programs for improvement of specific social skills of schizophrenics--a controlled study

Based on the Integrated Psychological Therapy (IPT) for schizophrenia patients, the Berne group developed three specific cognitive behaviour therapy programmes for treating residential, vocational, and recreational functioning. We added new cognitive-emotional methods to these programmes that were devised especially for schizophrenia patients, taking into consideration the criticism of traditional social skill training methods. In the present multicentre study, these new programmes (experimental group) were compared with a traditional social skills training programme (control group, IPT "Social Skills" subprogramme). Both the therapy and aftercare phase each lasted 12 weeks and the follow-up phase 1 year. Assessment instruments covered psychopathology, cognitive functioning, and social adjustment. Higher ratings of global treatment effects and significant reductions in symptoms were obtained in the experimental group. In view of the favourable results, these newly designed social skill training programmes may replace more conventional therapy approaches in the future.     

Outcomes of the Chinese Basic Conversation Skill Module (CBCSM) for people with schizophrenia having mild to moderate symptoms and dysfunction in Hong Kong

Abstract

This study tested the effectiveness of a culturally adapted Chinese Basic Conversation Skill Module (CBCSM) for Hong Kong Chinese with schizophrenia. A total of 106 participants with schizophrenia who had mild to moderate levels of symptoms and dysfunction were recruited between January 2004 and September 2005. After random allocation, 35 participants were assigned to the CBCSM group with skill generalization training (SGT), 35 participants were assigned to the CBCSM group without SGT, and 36 participants were assigned to the placebo group. All participants were assessed by a blind rater at baseline, 5 weeks after commencement of skills training, and 3 and 6 months after completion of skills training on conversation skill mastery, subjective personal well being, and self esteem. After 15 sessions of intervention, the CBCSM group with SGT and the CBCSM group outperformed the placebo group in social skills. At the 6-month follow-up, social skill of CBCSM group with SGT was better than the CBCSM group and the placebo group. CBCSM with SGT was found to be effective in improving conversation skill of people with schizophrenia in Hong Kong. This combined strategy was also shown to be better than mere application of CBCSM in helping conversation skill mastery.     

Prediction of social skill acquisition in schizophrenic and major affective disorder patients from memory and symptomatology

Memory and symptomatology were examined as predictors of social skill acquisition in psychiatric inpatients participating in a social skills training program. Poor memory was related to pretreatment social skill impairments and slower rates of skill improvement during the intervention for patients with schizophrenia or schizoaffective disorder, but not affective disorder. Symptomatology was not consistently related to pretreatment social skill or changes in skill for either schizophrenic or affective disorder patients. The results suggest that cognitive deficits in schizophrenia are associated with impairments in social skill and that such deficits may limit the rate of skill acquisition and clinical response to social skills training interventions.     

Improvements in spontaneity and social functioning in patients with schizophrenia after cognitive training

Cognitive rehabilitation approaches are in the spotlight as a novel strategy for promoting social participation in patients with schizophrenia, as the connection between cognitive deficits and functional outcomes in schizophrenia has been consistently demonstrated over the last decade. Divergent thinking is typically applied when someone is confronted with questions that do not have a single fixed answer. We identified divergent thinking deficits in patients with schizophrenia using qualitative measures involving idea and design fluency tests, and found that the impairment in generating high-quality responses on divergent thinking tasks was an important determinant of poor community functioning among patients. Based on our findings, we suggested that divergent thinking was an important neurocognitive skill that deserves consideration as a potential target for intervention, and developed a training program specifically for divergent thinking deficits in patients with schizophrenia. We evaluated the effects of this program on measures of divergent thinking (e.g., fluency measures), negative symptoms, and social functioning. After the training program, participants in the divergent thinking program had significantly greater improvements on measures of idea fluency, negative symptoms, and interpersonal relations than the participants in the control program. These results suggest that interventions for divergent thinking in patients with schizophrenia may lead to improvements in patients' social functioning. In recent years, intrinsic motivation has become a focus of attention as a critical mechanism for explaining the relationship between neurocognition and psychosocial functioning in patients with schizophrenia. Divergent thinking is thought to be relevant to spontaneity and intrinsic motivation. The training program for divergent thinking deficits may have achieved its effects on negative symptoms and social functioning through an improvement in spontaneity and intrinsic motivation. The potential of the cognitive training program to enhance patients' quality of life is discussed.     

全程干预对首发精神分裂症患者的影响

目的:探讨全程综合性干预对首发精神分裂症患者社会功能及生活质量的影响。方法:将116例首发精神分裂症患者随机分为干预组和药物组各58例,其中脱落7例。两组均接受抗精神病药治疗,干预组同时接受全程综合干预措施1年。采用简明精神病评定量表(BPRS)、住院病人护士观察量表(NOSIE-30)、社会功能缺陷量表(SDSS)和生活质量综合评定问卷(GQOLI)分别于入组时及干预结束时进行评估。结果:入组时,两组所有量表评分差异均无显著性;干预结束时,干预组的BPRS、NOSIE-30中的总消极因素及SDSS评分均明显低于药物组;而NOSIE-30总分、总积极因素及GQOLI评分均明显高于药物组。结论:全程综合性干预措施有助于改善首发精神分裂症患者的精神症状,促进其社会功能的恢复,提高其生活质量。