家庭心理干预对首发精神分裂症患者的影响

目的:探讨家庭心理干预对首发精神分裂症患者社会功能及复发率的影响。方法:采用随机抽样方法将84例首发精神分裂症住院患者随机分为干预组和药物组。干预组在药物治疗的基础上,从患者精神症状基本缓解开始实施家庭心理干预。药物组仅接受药物治疗。入组时和治疗9个月、1年后分别进行简明精神病评定量表(BPRS)和社会功能缺陷筛选量表(SDSS)评定。结果:经9个月的家庭心理干预后,干预组BPRS总分及自知力因子分与药物组相比明显降低。1年后两组患者的治愈率、复发率和病残率均以干预组显著较好。结论:家庭心理干预对提高精神分裂症患者疗效,改善其社会功能,防止复发有重要作用。     

心理干预治疗对缓解期精神分裂症的作用

目的探讨精神分裂症患者缓解期应用抗精神病药物联合心理干预治疗的临床疗效及对患者生活质量、社会功能的影响。方法选取123例缓解期精神分裂症患者,随机分为观察组61例,对照组62例。观察组在给予药物治疗的同时联合心理干预治疗,每周进行1次心理干预治疗;对照组只应用药物治疗,观察8周,并随访6个月。治疗前后应用阳性与阴性症状量表(PANSS)、社会功能缺陷筛选量表(SDSS)、世界卫生组织生活质量量表(WHOQOL-100)进行评估。结果入组时PANSS、WHOQOL-100及SDSS评分组间比较差异均无统计学意义(P0.05);随访结束时,观察组PANSS总分、阴性症状、阳性症状和SDSS评分均显著低于对照组(P0.01);WHOQOL-100中社会关系领域评分、独立性领域、生活质量总评分均较对照组高(P0.05或0.01)。结论心理干预治疗缓解期精神病分裂症患者效果显著,患者精神情况、生活品质以及社会功能均显著提高。     

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。     

社会心理干预对慢性精神分裂症患者生活质量的影响

目的探讨社会心理干预对慢性精神分裂症患者生活质量的影响。方法将80例慢性精神分裂症患者随机分为干预组和对照组,各40例,对照组单用药物治疗,干预组合并社会心理干预。在人组时及第6、12个月分别对两组采用PANSS评定患者病情,社会功能缺陷筛选量表（SDSS）和生活质量综合评定问卷（GQOLI-74）评定患者社会功能及生活质量。结果干预组SDSS总分在6个月及12个月时均显著低于对照组,干预组GQOLI-74评分在6个月和12个月时除物质生活维度外,其他三个维度均显著高于对照组。两组PANSS评分则无显著性差异。结论社会心理干预可改善患者社会功能,提高患者生活质量。     

综合心理干预对精神分裂症患者社会功能的影响

目的探讨综合心理干预对精神分裂症的疗效及社会功能恢复的影响情况。方法精神分裂症患者100例,随机分为研究组（50例）和对照组（50例）,研究组采用生物、心理、社会综合心理干预的方法,对照组采用单一药物治疗。两组治疗前和出院时及出院后一年,由经过统一培训的医生评定患者社会功能残疾评定量表（DAS）,对于复发等有关情况进行统计,采用两样本均数比较的t检验及卡方检验。结果治疗前两组患者的DAS评分无明显差异（P〉0．05）,出院3月后DAS调查显示,研究组明显低于对照组（P〈0．05）,出院1年后研究组DAS非常明显低于对照组（P〈0．01）。结论综合心理干预可降低精神分裂症的复发率,有效减缓其社会功能的减退。     

早期干预对首发精神分裂症患者的影响

目的：探讨早期干预对首发精神分裂症患者疗效和社会功能康复的影响。方法：干预组为50例首发精神分裂症患者，在药物治疗同时辅以心理和社会综合干预措施，50例与之匹配的对照患者单用药物治疗。采用阳性症状和阴性症状量表(PANSS)及社会功能缺陷筛选量表(SDSS)分别进行随访评定。结果：干预组随访时PANSS阴性量表分的改善明显优于对照组；SDSS的职业和工作、家庭外社会活动、家庭职能、个人生活自理、责任性和计划性5项因子分的改善明显优于对照组。结论：早期干预措施有助于提高精神分裂症患者的疗效和促进社会功能的康复。     

心理社会干预对精神分裂症结局的作用

本文对几种常用的改善精神分裂症结局的心理社会干预方法进行了综述。     

集体心理干预对精神分裂症患者的康复作用

目的 探讨集体心理干预对恢复期精神分裂症患者的康复作用。方法 将200例恢复期住院精神分裂症患者随机分成两组,对其中的100例进行集体心理干预(干预组),并与对照组(未干预)比较。采用BPRS、IPROS、SDS及SAS于干预前和干预后3个月时进行量表评定。结果 干预组在干预后3个月时患者的社会功能缺陷程度明显降低,IPROS总分与干预前比较有非常显著性差异(P<0.01),BPRS总分较干预前有极显著性差异(P<0.001),同时患者的焦虑、抑郁情绪亦均有明显的减轻,SAS及SDS标准分与干预前比较均有非常显著性差异(P均<0.01);而对照组除BPRS总分较前有显著性差异外(P<0.05),其余各量表均无显著性差异(P均>0.05)。两组在干预后各量表评分比较均有非常显著性差异(P均<0.01)。结论 临床上对恢复期精神分裂症患者实施集体心理干预,能帮助患者减轻心理障碍,提高社会适应能力。     

心理干预对首发精神分裂症康复期患者疗效影响分析

目的探索心理干预对康复期精神分裂症患者的疗效与影响。方法研究对象为在我院精神1、2科住院治疗的首发精神分裂症患者,出院前1月对干预组患者实施心理干预,对照组按正常治疗出院。出院时进行阳性和阴性症状量表(PANSS)、大体评定量表(GAS)评分。干预组出院后进行定期的电话和上门随访;对照组一般门诊随访。在3个月,6个月,1年时再分别对两组患者做PANSS、GAS、康复状态评定量表(MRSS)、社会功能缺陷筛选量表(SDSS)测定。结果干预组PANSS、MRSS、SDSS分值逐步下降,GAS分值升高,与对照组比较差异有显著性;干预组服药依从性、自觉门诊随访率显著高于对照组,再住院率低于对照组(P<0.01)。结论对首发精神分裂症患者康复期进行心理干预可以提高临床疗效,改善阳性症状,提高社会功能并能增加服药的依从性,减少复发。     

社会心理干预对精神分裂症认知功能的影响

目的:探讨社会心理干预对精神分裂症患者认知功能的影响。方法:收集精神分裂症患者120例,分成氯丙嗪、氯氮平、利培酮、奥氮平及奎硫平等药物治疗组,每一组又分为单纯药物治疗组(单纯药物组)和社会心理综合干预治疗组(综合治疗组)。在治疗6个月和12个月时采用威斯康星卡片分类测验(WCST)中正确数(W1)和持续错误数(W2)以及持续操作测验(CPT)中错误数(C1)和漏报数(C2)等指标评定认知功能。结果:治疗6个月及12个月时,综合治疗组W1均显著高于单纯药物组、W2均显著低于单纯药物组;综合治疗组C1、C2均显著低于单纯药物组,尤以服用第二代抗精神病药治疗组更为显著。结论:社会心理干预能改善精神分裂症患者认知功能。     

首发精神分裂症早期干预的康复效果

目的　探讨早期干预措施对首发精神分裂症患者的康复效果。方法　将 6 2例首发男性精神分裂症住院患者随机分为干预组 (30例 )和对照组 (32例 ) ,在利培酮治疗的同时 ,对干预组予以心理社会干预措施 ,观察时间为 8周 ,出院后随访 6个月。用阴性、阳性症状评定量表 (PANSS)、住院病人护士观察量表 (NOSIE 30 )和复发率进行评估。结果　入组时与随访最后时点评分差值的比较 ,干预组患者的PANSS总分 (4 6 37± 13 6 5 )、阳性症状分 (18 2 4± 5 83)、阴性症状分 (14 5 5± 5 4 0 )均优于对照组 (分别为 4 1 5 9± 14 6 3、15 30± 6 2 2、19 84± 7 36 ,P <0 0 5～P <0 0 1) ;干预组患者的积极因素分 (- 38 6 5± 9 79)、消极因素分 (31 0 2± 12 5 3)、总评估分 (- 6 6 30± 14 4 5 )皆显著优于对照组 (分别为 - 9 6 7± 11 2 3、3 18± 14 4 7、- 11 6 2± 2 3 75 ,P均 =0 0 0 0 ) ;干预组的复发率 (6 6 7% )低于对照组 (18 75 % ) ,但差异无显著性。结论　对首发精神分裂症患者早期干预措施 ,能较好改善患者的精神症状、提高社会功能、降低复发率 ,故有利于患者重返社会     

Treatment of the first episode of schizophrenia: An update on pharmacologic and psychological interventions

This review emphasizes the recent findings on different pharmacologic and psychological interventions in the treatment of first-episode schizophrenia. Most controlled studies demonstrate that first-and second-generation antipsychotics produce a similar reduction in symptom severity and an overall equal likelihood of clinical response. The cognitive improvements found across atypical antipsychotics were similar and consistent in magnitude with practice effects observed in healthy controls. However, the differential effect of low doses of haloperidol on cognitive function compared with that of second-generation antipsychotics is still debated. The different pattern of metabolic side effects induced by long-term use of antipsychotics is a crucial concern when selecting an antipsychotic treatment for a first-episode patient. More long-term studies are necessary to elucidate the metabolic effects of the different antipsychotic drugs. Cognitive-behavioral therapy and family interventions seem to be effective adjunctive treatments in early phases of schizophrenia in some patients.     

Spontaneous dyskinesia in first episode schizophrenia

In the west London prospective study of first episodeschizophrenia, the prevalence and nature of abnormal involuntarymovements were examined in 27 patients who had never receivedantipsychotic drugs and 36 who had been treated with such medication.Motor disturbance was assessed with rating scales designed to cover thefull range of spontaneous and drug induced movement disorder. Only oneperson in the drug naïve group showed evidence of parkinsonism, afinding which contrasts with recent reports suggesting that spontaneousextrapyramidal signs may not be uncommon in such patients. However,according to ratings on the modified Rogers scale, 11% of the drugnaïve group exhibited orofacial dyskinesia, 4% trunk and limbdyskinesia, 7% postural abnormalities, and 4% increased muscle tone.The respective figures in the closely matched medicated group were notsignificantly different except for increased muscle tone, which wassignificantly more common (25%). The proportion of drug naïvepatients fulfilling criteria for tardive dyskinesia on the abnormalinvoluntary movements scale ranged from 4% to 11% depending on thecriterion threshold score used. These findings are in accord with thenotion that abnormal involuntary movements, particularly orofacialdyskinesia, represent a neuromotor component of schizophrenia.

     

Disease-relevant autoantibodies in first episode schizophrenia

Journal of Neurology -     

One year outcome in first episode schizophrenia

The aim of this study was to identify the predictors of outcome at one year follow-up after the first psychotic episode of schizophrenia. Seventy-nine first-episode schizophrenia patients were assessed monthly with the Brief Psychiatric Rating Scale (BPRS), Scale for Assessment of Positive Symptoms (SAPS), and Scale for Assessment of Negative Symptoms (SANS) after discharge from their first hospitalization. Outcome measures were presence of relapse and rehospitalization, level of global functioning, employment status and severity of symptoms at one year. A total of 33% of the patients had a relapse, and 12.1% were rehospitalized during one year follow-up. Premorbid childhood functionality was worse in patients who had relapse, but there was no correlation between premorbid adjustment scores and BPRS, SANS and SAPS scores at one year. There was no difference in duration of untreated psychosis (DUP) between patients who had relapse and not; however, the patients who had double relapse, had longer DUP than those without relapse. The time period between discharge and rehospitalization was shorter in patients with longer DUP. Functionality in childhood and noncompliance to the treatment independently contributed to the relapse rate. Functionality in late adolescence independently contributed to the Global Assessment of Functioning (GAF) scale score at one year and the GAF score at discharge appeared as a predictor of employment. The results of the present study suggest that treatment compliance and early premorbid adjustment level seem to be important predictors of relapse rate in first episode schizophrenia.     

Spatio-temporal EEG waves in first episode schizophrenia

ObjectiveSchizophrenia is characterized by a deficit in context processing, with physiological correlates of hypofrontality and reduced amplitude P3b event-related potentials. We hypothesized an additional physiological correlate: differences in the spatio-temporal dynamics of cortical activity along the anterior–posterior axis of the scalp.MethodsThis study assessed latency topographies of spatio-temporal waves under task conditions that elicit the P3b. EEG was recorded during separate auditory and visual tasks. Event-related spatio-temporal waves were quantified from scalp EEG of subjects with first episode schizophrenia (FES) and matched controls.ResultsThe P3b-related task conditions elicited a peak in spatio-temporal waves in the delta band at a similar latency to the P3b event-related potential. Subjects with FES had fewer episodes of anterior to posterior waves in the 2–4 Hz band compared to controls. Within the FES group, a tendency for fewer episodes of anterior to posterior waves was associated with high Psychomotor Poverty symptom factor scores.ConclusionsSubjects with FES had altered global EEG dynamics along the anterior–posterior axis during task conditions involving context update.SignificanceThe directional nature of this finding and its association with Psychomotor Poverty suggest this result is related to findings of hypofrontality in schizophrenia.     

Correlates of cognitive deficits in first episode schizophrenia

OBJECTIVE: The presence of cognitive dysfunction in schizophrenia has been well documented, but questions remain about whether there are relationships between this dysfunction and clinical symptomatology. If present, such relationships should be most clearly observable in patients with first episode schizophrenia; that is, before the effects of chronic illness, institutionalization, or treatment might confound them. METHOD: 307 schizophrenia subjects in their first episode of illness were recruited to participate in a clinical trial comparing the long-term efficacy of haloperidol and risperidone. The psychopathology, cognitive functioning, early treatment history, and duration of untreated psychosis of these subjects were assessed prior to their assignment to randomized, double-blind treatment. Approximately two-thirds of the subjects were receiving antipsychotic treatment at the time of assessment; however, the duration of treatment was limited to 12 weeks or less. RESULTS: The severity of negative symptoms at the time of assessment was associated with deficits in memory, verbal fluency, psychomotor speed and executive function. Positive symptoms were not associated with cognitive deficits. Also, the duration of untreated illness (DUI) prior to assessment was not significantly associated with cognitive impairment. CONCLUSIONS: The results of this study of first episode schizophrenia patients suggest that a relationship exists between negative symptoms and cognitive dysfunction. However, that relationship accounts for only a minor portion of the variance (i.e., 10-15%) in the severity of cognitive dysfunction after controlling for a number of potentially confounding factors. This finding provides support for the theory that the neurobiological processes that give rise to symptomatology and cognitive dysfunction in schizophrenia are partially overlapping.     

首发精神分裂症住院病人疗效影响因素

目的 系统了解初发精神分裂症病人住院时疗效的影响因素。方法：采用前瞻性研究方法，应用简明精神病评定量表、阴阳必症状评定量表、艾森克个性问卷、社会支持评定量表、ＤＳＭ－Ⅲ轴Ⅴ病前社会适应功能水平评定、大体功能评定量表等工具，对符合ＣＣＭＤ－２诊断的１８４例连续就诊的住院精神分裂症病人进行评估。结果：初发精神分裂症病人出院时疗效的主要影响因素为：病前社会功能水平、客观家庭社会支持、思维贫乏、愉快感缺乏     

Depressive symptoms in first episode schizophrenia spectrum disorder

Background

Depressive symptoms in ‘non-affective’ first episode schizophrenia spectrum disorders (FES) are common, but poorly understood, resulting in a range of conceptual and clinical management issues. This study had three aims: (i) to determine the prevalence of moderate to severe depressive symptoms (defined as a Clinical Global Impressions Scale-Bipolar Disorder (CGI-BP depression) score > 3) in a large representative sample of FES patients; (ii) to compare the clinical and functional characteristics of FES patients with and without these depressive symptoms at service entry; and (iii) to compare the characteristics of FES patients with and without persistent depressive symptoms.

Methods

Medical file audit methodology was employed to collect information on 405 patients with FES treated at the Early Psychosis Prevention and Intervention Centre (EPPIC), Melbourne, Australia.

Results

26.2% (n = 106) of the patients had moderate to severe depression at service entry. At service entry and at discharge, those with depressive symptoms had greater insight into their illness but did not differ from those without depressive symptoms in terms of severity of overall psychopathology. Substance use was significantly less common in those with depressive symptoms at service entry and at discharge. Of those who were depressed at baseline, 14.2% (n = 15) continued to have moderate to severe depressive symptoms at discharge.

Discussion

Depressive symptoms are common in patients with FES. Understanding the nature and characteristics of depression in FES has important clinical implications for both early intervention and treatment.