慢性精神分裂症住院患者的程式化技能训练

目的:探讨程式化技能训练对慢性精神分裂症住院患者的康复效果.方法:将 120 例住院患者随机分成训练组和对照组各 60 例,对训练组进行 8 周的程式化训练,然后全部随访 24 周.采用阳性与阴性症状量表(PANSS),自知力与治疗态度问卷(ITAQ)和 Morningside 康复状态量表(MRSS)进行评估.结果:训练组的 PANSS 总分、阴性症状分和一般精神病理分及 ITAQ 分以及 MPSS 各量表分在训练第 20 周末起,都明显优于对照组.结论:程式化技能训练可使慢性精神分裂症住院患者增进多方面的康复效果.     

系统康复治疗对慢性精神分裂症患者的随访研究

目的探讨系统康复治疗对慢性精神分裂症患者的康复效果。方法将80例慢性精神分裂症患者按入院顺序分为康复组和对照组,每组40例。在常规住院治疗的基础上单独对康复组病人施以为期3个月的系统康复治疗,用BPRS、自知力与治疗态度问卷（ITAQ）和社会功能缺陷筛选量表（SDSS）于入组时、出院时和出院后1a对患者进行相关评定。结果出院时2组BPRS、SDSS、ITAQ总分均较入组时有明显改善,康复组较为明显（P〈0.05或P〈0.01）;并维持至出院1a仍显著优于对照组（P〈0.05）;且1a内的复发率和再住院率显著低于对照组（P〈0.05）。结论系统康复治疗可提高慢性精神分裂症患者的治疗依从性,改善患者的精神症状,降低复发率和再住院率,有益于患者社会功能恢复。     

家属参与的社会技能训练对社区精神分裂症患者康复的作用

目的:探讨家属参与的社会技能训练对社区精神分裂症患者康复的影响。方法:80例社区的精神分裂症患者随机分为试验组和对照组;在抗精神病药物治疗基础上所有患者在社区接受每周1次、每次60 min的社会技能训练,共训练16次。试验组每例患者均有1位家属参与训练,其接受治疗师单独指导及在家庭生活中帮助患者实践所学到的技能。两组在训练前、训练6及12个月时分别进行大体评定量表(GAS)、社会功能缺陷筛选量表(SDSS)、自知力和治疗态度问卷(ITAQ)及日常生活量表(ADLS)的评定。结果:训练后试验组SDSS(F=4.02,P0.05)、ADLS(F=12.73,P0.01)及工具性日常生活活动量表(IADL)(F=15.11,P0.01)减分值明显优于对照组。结论:有家属参与的社会技能训练能更好地帮助社区精神分裂症患者康复。     

肇事肇祸精神分裂症患者院内重返社会程式训练及其疗效的一年随访

目的探讨重返社会程式训练对肇事肇祸精神分裂症患者的疗效。方法采用随机数字表法,将90例康复期肇事肇祸精神分裂症患者分为研究组和对照组各45例,研究组接受12周的重返社会程式训练,出院后随访一年,并对两组进行阳性和阴性症状量表(PANSS)、外显攻击行为量表(MOAS)、社会功能缺陷评定量表(SDSS)评定。结果研究组有43名完成随访、对照组有44名完成随访。1与入组时比较,住院期间研究组PANSS减分除第2周末外,其它各时间点(4周、8周、12周末)减分的幅度均大于对照组(P0.01);2出院时与随访第12月末评定差值的比较,研究组的PANSS总分、MOAS、SDSS减分值分别为(3.16±2.13)分、(0.42±0.34)分、(4.04±2.13)分,与对照组比较,差异均有统计学意义(P均0.01);3研究组的复发率和再住院率均低于对照组,差异有统计学意义(11.6%vs.25.0%,2.3%vs.11.4%,P均0.05);4研究组的攻击行为发生率低于对照组,差异有统计学意义(4.7%vs.15.9%,P0.01)。结论重返社会程式训练对控制肇事肇祸精神分裂症患者的病情、提高社会功能、降低复发率和再住院率以及减少攻击行为的再次发生具有重要的作用。     

社区精神分裂症患者应用重返社会程式训练的一年随访研究

目的探讨重返社会技能训练程式对于社区精神分裂症患者康复的作用.方法将100例非急性期的社区精神分裂症患者随机分为技能训练组(以下简称训练组;50例,其中脱落5例)和对照组(50例,其中脱落2例).在药物治疗的同时,对训练组进行重返社会技能训练,对照组接受传统精神康复干预,对两组患者随访1年.采用阳性和阴性症状量表(PANSS)和Morning Side康复状态量表(MRSS),在干预前、随访第1,3,6,9,12个月时对患者进行评估;同时监测病情复发率、(再)住院率、(再)就业率.结果 (1)入组时与随访末次评分减分值的比较,训练组PANSS总分[(6.80±11.30)分]、阳性量表[(0.51±3.36)分]、阴性量表[(3.14±5.27)分]、一般精神病理量表[(3.14±5.11)分]和MRSS总分[(13.92±21.08)分]均优于对照组[分别为(-4.33±18.35)分、(-2.93±7.16)分、(-1.23±7.27)分、(-0.16±7.97)分和(-10.09±30.93)分],P＜0.05～0.01;(2)训练组的病情复发率(20%)和(再)住院率(2%)低于对照组(分别为40%和19%;P＜0.05);(3)训练组的(再)就业率(51%)高于对照组(23%;P＜0.01).结论在药物治疗的基础上,重返社会程式可以有效地帮助精神分裂症患者尽早地重返社会.     

综合康复训练对精神分裂症患者社会功能的影响

目的 了解社区精神分裂患者经系统的康复技能培训后社会功能的改善情况.方法 由培训过的社区兼职医师对56例精神分裂症患者和家属分组进行康复技能培训,于培训前、培训后6个月、12个月与50例对照组进行FIS、PANSS、MRSS、ITAQ、住院率、复工率、正规服药率比较.结果 6个月后干预组与对照组各量表除PANSS外减分无统计差异,12个月后除ITAQ外差异有统计学意义.干预组的正规服药率、复工率明显高于对照组,住院率低于对照组(P＞0.05);再就业率高于对照组(P＞0.05).结论 完善、系统的康复技能培训对于降低社区精神分裂症患者的复发率,帮助早日回归社会具有重要的作用.     

个体服务计划对农村社区精神分裂症患者康复的影响

目的:探讨个体服务计划(ISP)社区康复管理模式对农村精神分裂症患者康复的影响。方法:按随机数字表法将2个乡镇110例精神分裂症患者分为研究组和对照组各55例,并分别实施ISP社区康复管理模式或现行的社区管理模式6个月。患者入组时、入组后3及6个月给予自知力与治疗态度问卷(ITAQ)、服药依从性量表评定;比较1年后两组的复发率。结果:干预前两组患者ITAQ总分、治疗依从性比较差异均无统计学意义;干预后3及6个月时两组ITAQ总分较基线显著提高(P均0.01);且研究组ITAQ评分及服药依从性明显高于对照组(P均0.01);随访1年研究组复发率(24.53%)显著低于对照组(43.14%)(P0.05)。结论:ISP社区康复管理模式对改善农村精神分裂症患者的自知力、提高治疗依从性、降低复发率有一定的作用。     

药物自我处置程式对精神分裂症依从性、社会功能和生活质量的影响

目的探讨药物自我处置程式对精神分裂症患者治疗依从性、社会功能和生活质量的影响。方法 66例住院非急性期精神分裂症患者随机分为训练组和对照组,训练组在抗精神病药物治疗的基础上给予药物自我处置程式训练8周,8周后随访1年。采用自制的药物依从性评分表、社会功能缺陷量表(social disability screening schedule,SDSS)、生活质量综合评定问卷(generic quality of life inventory-74,GQOIL-74)对两组患者进行评估。结果训练8周后、随访6个月及12个月,与同时点的对照组比较,训练组的治疗依从性(U值为141.00、447.00、353.50)、GQOLI-74总分(F值为5.90、8.35、9.77)均提高(P均小于0.05),而SDSS总分下降(U值为291.50、254.50、230.50,P均小于0.01)。训练组8周时、随访6个月及12个月时治疗依从性(Z值为-4.71、-4.43、-4.22)、SDSS总分(Z值为-4.71、-4.58、-4.85)、GQOLI-74总分均较入组时改善(P均小于0.01);训练组随访12个月时及对照组随访6个月、12个月时的治疗依从性均较8周时下降(Z=-2.24,P0.05;Z=-3.27,P0.01;Z=-3.40,P0.01);训练组随访6个月、12个月时的SDSS总分也均较8周时下降(Z=-2.57,P0.01;Z=-3.33,P0.01),GQOLI-74总分提高(P0.05)。随访12个月时全部患者GQOLI-74总分与SDSS总分、治疗依从性呈负相关(r=-0.57,P0.01;r=-0.50,P0.01),SDSS总分与治疗依从性呈正相关(r=0.61,P0.01)。结论药物自我处置程式训练能提高患者的治疗依从性,改善其社会功能,提高其生活质量。     

易肇事精神分裂症患者应用程式化技能训练的疗效研究

目的 探讨程式化技能训练对易肇事精神分裂症患者的疗效.方法 将102例易肇事精神分裂症患者随机分为训练组(51例)和对照组(51例).两组患者接受常规药物及康复治疗的同时,仅对训练组进行8周的程式化技能训练.训练结束后对两组均进行半年的随访,并采用阳性和阴性症状量表(PANSS)在入组时、训练结束时、随访第3,6个月时进行评估.结果 与入组时相比,训练组患者训练结束时的PANSS总分、阳性量表分、阴性量表分均显著降低(P＜0.05).训练结束后及随访期,训练组患者的PANSS部分项目评分显著低于对照组患者(P＜0.05).结论 程式化技能训练对易肇事精神分裂症患者的精神症状具有康复作用.     

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。     

Effect of the medication management module evaluated using the role play test

Abstract Training in social skills has been shown to have a strong, positive impact, according to behavioral measures, on social skills, self-rated assertiveness, and the hospital discharge rate. It is important to establish a system of assessing social skills because it is necessary for the effects of social skills training to be assessed in Japan. In Project 1, we devised a Japanese version of the role play test to quantify social skills using a standard method. We tested 30 patients attending the day hospital who were considered to need intensive rehabilitation. We found the role play test had high inter-rater and test-retest reliability, and had construct validity and criterion related validity. Thus, the role play test was thought to be a useful tool for assessing social skills. For Project 2, eight inpatients who were ready for discharge but who needed to improve their skills in self-managed medication participated in this study. The social skills of self-managed medication assessed using the role play test were significantly improved after the subjects participated in the Medication Management Module of the UCLA social and independent living skills program. Knowledge of self-managed medication also tended to improve after training. This study is preliminary and it should be confirmed that improved skills influenced by the medication management module decreases the relapse rates.     

A new module for on-line manipulation and display of molecular information in the brain architecture management system

A new “Molecules” module of the Brain Architecture Management System (BAMS; http://brancusi.usc.edu/bkms) is described. With this module, BAMS becomes the first online know ledge management system to handle central nervous system (CNS) region and celltype chemoarchitectonic data in the context of axonal connections between regions and cell types, in multiple species. The “Molecules” module implements a general knowledge representation schema for data and metadata collated from published and unpublished material, and allows insertion of complex reports about the presence of molecules collated from the literature. For different CNS neural regions and cell types the module's database structure includes representation of molecule expression revealed by various techniques including in situ hybridization and immunohistochemistry, molecule coexpression and time-dependent level changes, and physiological state of subjects. The metadata representation allows online comparison and evaluation of inserted experiments, and “Molecules” structure allows rapid development of data transfer protocols enabling neuroinformatics visualization tools to display gene expression patterns residing in BAMS, in terms of levels of expressed molecules and in situ hybridization data. The module's web interface allows users to construct lists of CNS regions containing a molecule (depending on physiological state), retrieve further details about inserted records, compare time-dependent data within and across experiments, reconstruct gene expression patterns and construct complex reports from individual experiments.     

Ataxia and the olivo-cerebellar module

Ataxia is a neurological symptom characterized by abnormal movement, due to cerebellar malfunction. Although the cause of the malfunction varies, from mutations in calcium or potassium channels to progressive degeneration of cerebellar tissue, the neurological symptoms of cerebellar-related ataxia are similar. In this short review we present a model that portrays the olivo-cerebellar system as a generator of temporal patterns. We then use the model to explain how mutations in different ionic channels located in different parts of the cerebellar system can result in similar neurological symptoms.     

Training patients with schizophrenia with the community re-entry module

Background There is increasing evidence indicating that the Community Re-entry Module (CRM), a brief, structured instrument, could guide an effective intervention for patients with schizophrenia. This study evaluated the effectiveness of the Chinese version of the CRM with respect to improvement in psychiatric symptoms, social functioning as well as relapse and re-hospitalization rates in comparison with a supportive counseling (SC) intervention. Method Ninety-six outpatients with DSM-IV schizophrenia were randomly allocated to either CRM (N=48) or an equally intensive intervention of SC (N=48). The CRM was composed of 16 one-hour sessions, which were conducted with groups of 6–8 patients on a twice-a-week schedule. The two groups received routine psychiatric outpatient care during the intervention. Participants were assessed on an intention-to-treat basis with the Positive and Negative Syndrome Scales (PANSS), with the Social Disability Screening Schedule (SDSS) by two independent raters before and immediately after intervention, and at 6-month follow-up. The number of relapse and re-hospitalization were also documented. Results The CRM group significantly improved in terms of psychiatric symptoms and social functioning compared with the SC group. Rates of relapse and re-hospitalization in the CRM group were lower although the difference between the two groups was not statistically significant. Conclusions The study supports the feasibility and effectiveness of the Chinese version of the CRM as an effective psychosocial intervention for Chinese patients with schizophrenia to improve psychopathology, social functioning and relapse and re-hospitalization rates.     

Reliability and validity of the substance abuse outcomes module

OBJECTIVE: The study sought to determine the validity and reliability of the Substance Abuse Outcomes Module (SAOM), a self-report tool designed to assess patient characteristics, process of care, and outcomes of care, using a minimum amount of information, in order to improve treatment. METHODS: A longitudinal field test (baseline and three-month follow-up) compared the SAOM to seven other research instruments in the assessment of 100 substance-abusing patients who were entering a new treatment episode. Quota samples of patients were drawn from two private inpatient substance abuse treatment facilities and an outpatient methadone clinic. The study's primary outcome measures were diagnostic accuracy, internal and test-retest reliability of key constructs, concurrent and predictive validity, and sensitivity to change. Cronbach's alpha coefficients were calculated to examine internal consistency and reliability. Intraclass correlation coefficients and kappa coefficients were used to examine test-retest reliability. Concurrent validity of outcomes measures was examined with Pearson or Spearman correlation coefficients and chi square and kappa statistics. Changes between baseline and follow-up were examined as a function of case-mix measures with ordinary least-squares multiple regression. Sensitivity to change was examined by calculating effect size scores. RESULTS: The SAOM had high internal consistency and a high level of agreement with research diagnoses at baseline and follow-up. The SAOM was found to be highly reliable, to have very strong validity, and to be sensitive to clinical change. CONCLUSIONS: The SAOM appears to be a reasonably reliable and valid self-report instrument when used to monitor substance abuse treatment among patients with a primary substance use diagnosis.