社会职业技能训练对农村精神分裂症患者社会功能恢复的影响

目的：探讨农村社区精神分裂症患者残疾功能恢复的方法及社会职业技能训练的效果。方法：2000—06／2003—06将枣庄市3个农村精神疾病社区康复试点乡镇已登记的精神分裂症患者中符合入组条件的300例患者随机分成训练组和对照组，每组各150例。两组均服小剂量抗精神病药(折合氯丙嗪剂量为&;lt;300mg／d)，其中训练组同时接受社会技能训练及个案职业康复训练；于入组时和随访每1年末评定1次社会功能缺陷筛选量表(SDSS)，同时进行残疾功能评定分级。3年共评4次：结果：①人组时训练组与对照组相比SDSS和残疾等级评定差异无显著性意义(P&;gt;0．05)。②综合干预1年时，训练组SDSS的职业和工作(0．76&;#177;0．70）、婚姻职能(0．27&;#177;0．54)、父母职能(0．26&;#177;0．54)、社会性退缩(0．55&;#177;0．61)、家庭外的社会活动(0．63&;#177;0．64)、家庭内活动过少(0．29&;#177;0．48)、家庭职能(0．33&;#177;0．54)、个人生活自理(0．20&;#177;0．40)、对外界的兴趣和关心(0．83&;#177;0．70)、责任心和计划性(0．84&;#177;0．72)10个因子评分和量表总分(4．32&;#177;4．69)明显低于对照组（P&;lt;0．01），残疾程度明显地轻于对照组，差异有非常显著性意义(P&;lt;0．01)，这一结果一直持续到随访结束。结论：社会职业技能训练方法能有效地改善农村社区精神分裂症患者社会功能，降低残疾程度。     

个别系统家庭干预对精神分裂症患者家庭功能和社会功能的作用:随机对照研究

目的:探讨个别系统家庭干预,对精神分裂症患者家庭功能和社会功能的作用。方法:将济宁市精神病防治院221例精神分裂症患者及家属按入院顺序分层随机法,分为研究组和对照组,待患者病情缓解出院后随访3年。前半年进行10次系统精神医学知识指导,研究组进行个别系统家庭干预,对照组进行集体系统家庭干预,于出院时和出院后1,2和3年末评定两组家庭功能量表、社会功能缺陷量表(SDSS)。结果:出院3年后研究组家庭功能的问题解决能力(1.35±0.78),沟通能力(1.39±0.45),角色定位和转换(1.22±0.46),情感的协调性(1.48±0.78),情感介入(1.62±0.95),行为控制(1.22±0.58),总分(1.27±0.66)较对照组降低明显,差异有显著性(t=2.10～2.79,P<0.05～0.01);研究组社会功能评定量表的职业和工作(0.69±0.11),婚姻职能(1.13±0.23),父母职能(0.66±0.16),社会交往(0.94±0.21),家庭外的社会功能(1.00±0.21),家庭内的社会功能(1.00±0.28),家庭职能(1.00±0.26),个人卫生自理能力(0.78±0.22),对外界的兴趣和关心(0.93±0.26),责任心和计划性(1.05±0.23)和总分(9.15±0.54)较对照组降低明显,差异具有显著性意义(t=1.97～2.63,P<0.05～0.01)。结论:个别系统家庭干预能显著改善精神分裂症患者的家庭功能和社会功能。     

程式训练对社区慢性精神分裂症患者社会功能的影响

目的:探讨程式训练对社区慢性精神分裂症患者社会功能康复的作用。方法:将日间康复站慢性精神分裂症患者120例,随机分为训练组和对照组各60例。训练组采用程式训练,对照组采用常规方法。用社会功能缺陷筛选量表(SDSS)、日常生活能力量表(ADL)进行效果评定。结果:训练组训练后SDSS评分低于对照组(P0.01);ADL总分明显低于对照组(P0.01)。结论:程式训练对社区慢性精神分裂症患者社会功能的康复有积极的促进作用。     

家庭-社区-医院康复管理模式对社区精神分裂症康复的作用

目的探讨家庭-社区-医院康复管理模式对社区精神分裂症患者康复的效果。方法将110例社区精神分裂症患者分为对照组(n=60)和训练组(n=50)。对照组患者每月随访1次;训练组患者参加家庭-社区-医院康复。用社会功能缺陷筛选量表(SDSS)、总体幸福感量表(GWB)、自尊量表(SES)在入组前及训练结束后对两组患者同步测定并比较;用自设问卷,于入组前和训练结束后对两组患者服药依从性、药物管理形式同步评定并比较。结果入组前两组患者SDSS、幸福感、自尊程度、服药依从性、药物管理形式无差异(P>0.05),训练结束后训练组以上各项指标明显高于对照组(P<0.01)。结论家庭-社区-医院康复管理模式能明显改善精神分裂症患者的社会功能,提高他们的总体幸福感和自尊心,同时也能提高服药依从性和药物自我管理能力。     

重返社区技能训练对精神分裂症患者社会功能的改善

目的:探讨重返社区技能训练在社区精神分裂症患者康复中的作用。方法:采用由Liberman等编制的重返社区技能训练,对60例社区精神分裂症患者进行研究,并设60例未实施者作对照。分别于入组前、8周末、26周末,应用阳性症状评定量表(SAPS)、阴性症状量表(SANS)、社会功能残疾量表(DAS)对两组进行评定,并作两组间患者服药依从性及复发率的对照比较。结果:入组前两组SAPS、SANS、DAS差异不显著(P>0.05);8周末两组间SAPS、SANS(训练组:8.1±3.7,11.8±5.0;对照组:9.5±5.1,14.4±5.7)差异显著(t=1.76,2.64;P<0.05),26周末两组间SAPS、SANS,DAS(训练组:8.3±3.0,9.7±4.1,9.4±7.6;对照组:10.2±4.5,18.1±5.4,16.2±12.6)均存有非常显著性差异(t=2.71,9.60,1.70;P<0.01);干预期间,训练组对服药完全依从者48例(80%),部分依从者12例(20%),不依从者0例;对照组分别为20例(33.3%)、28例(36.7%)、12例(20%);训练组有6例(10%)复发,对照组为18例(30%);两组的服药依从性及复发率比较亦存有非常显著性差异(χ2=6.36,P<0.01)。结论:重返社区技能训练能改善精神分裂症残留精神病症状,提高社会功能,并且对提高服药依从性、减少疾病的复发率具有积极的作用。     

社区独立技能训练预防精神分裂症复发的研究

目的探讨社区独立技能训练对降低精神分裂症患者复发率、提高社会功能的作用.方法将120例临床康复出院的精神分裂症患者随机分为技能训练组和对照组.采用精神分裂症阳性症状量表(SAPS)、阴性症状量表(SANS)、简明精神病评定量表(BPRS)、自知力及治疗态度问卷(ITAQ)和社会功能缺陷量表(SDSS)对两组患者进行1年内康复状态的评估.结果 1年末训练组BPRS、 ITAQ、SDSS评分明显优于对照组,两组间差异有非常显著性意义(P<0.01);训练组服药依从性及自行管理药物的能力也明显优于对照组(P<0.01); 1年内训练组复发率(9%)和再入院率(6%)均明显低于对照组(分别为36%和30%),两组间差异有显著性意义(P<0.05).结论社区独立技能训练有助于改善精神分裂症残留症状,降低社会残疾程度,对保持精神分裂症患者良好的远期疗效具有积极作用.     

利培酮与氯氮平对首发精神分裂症患者社会功能的影响

目的:探讨利培酮与氯氮平对首发精神分裂症患者社会功能的影响。方法:采用社会功能缺陷筛选量表(SDSS)对106例(脱落23例,83例完成研究)首发精神分裂症患者的社会功能进行评定,并比较利培酮(n=43)与氯氮平(n=40)治疗首发精神分裂症患者对其社会功能的影响。结果:利培酮治疗的首发精神分裂症患者家庭内活动过少(3%,7/43)、家庭职能(3%,7/43)、个人生活自理缺陷发生率(5%,3/43)和SDSS分均显著低于氯氮平治疗的患者(χ2=4.847,4.847,4.295;t=0.718-2.684;P均<0.05);利培酮治疗的患者对外界的兴趣和关心SDSS分显著低于氯氮平治疗的患者(0.12±0.39和0.33±0.66,t=1.771,P<0.05)。结论:利培酮对首发精神分裂症患者社会功能的影响优于氯氮平。     

技能训练对社区精神分裂症患者社会功能的影响

目的探讨社会技能训练程式对社区精神分裂症患者的社会功能的影响。方法将100例康复期精神分裂症患者纳入我院社区开放管理体系,随机分为观察组和对照组各50例,对照组进行常规的随访,观察组按照社会技能训练程式进行为期15周的训练。并于训练前后以及半年后随访时用简明精神病评定量表(BPRS)、Morningside康复状态量表(MRSS)和社会功能缺陷筛选量表(SDSS)评定所有患者精神症状和社会功能。结果实际完成94例,训练组48例,对照组46例,两组患者入组前BPRS、MRSS和SDSS评分差异无统计学意义(P<0.05),训练15周后,两组间BPRS(P<0.05)、MRSS和SDSS评分差异有统计学意义(P<0.01),训练结束半年后随访时,两组间BPRS、MRSS和SDSS评分差异进一步扩大。结论社会技能训练程式可以显著改善社区精神分裂症患者的精神症状,并使其尽可能地掌握健康生活知识,提高社交能力,改善社会功能。     

首发精神分裂症患者社会功能缺陷与社会支持的对照比较

目的了解首发精神分裂症患者社会功能缺陷和社会支持状况。方法采用社会功能缺陷筛选量表(SDSS)和社会支持评定量表对106例首发精神分裂症患者的社会功能和社会支持进行评定,用非首发精神分裂症患者和非精神疾病患者作对照。结果(1)首发精神分裂症患者客观支持(8.1±2.1)、主观支持(19.8±3.5)、对支持的利用度(7.3±1.7)、社会支持总分(35.3±5.7)均明显低于对照组(t=2.28～5.02,P<0.01～0.05),高于非首发精神分裂症组患者(t=3.78～6.02,P<0.01)。(2)首发精神分裂症患者各项社会功能缺陷程度均明显低于非首发精神分裂症患者(χ2=4.20～18.43,P<0.05～0.001)。结论首发精神分裂症患者社会功能和社会支持均优于非首发精神分裂症患者,社会支持差于非精神疾病患者。     

家庭干预促进精神分裂症患者社会康复

目的:观察家庭干预对精神分裂症患者的综合性治疗效果。方法:160例精神分裂症患者随机分为家庭组和封闭组各80例,均接受药物治疗,家庭组同时进行家庭心理干预。采用简明精神病量表(BPRS)评定治疗效果、社会功能残疾评定量表(DAS)和生活质量量表(QOULI)评定患者的残疾程度和生活质量。结果:家庭组平均住院天数明显短于封闭组(56±7 d7、8±18 d,P<0.05);痊愈和显著进步率明显高于封闭组(72.2%、43.5%,P<0.01),无效或恶化率明显低于封闭组(8.3%、24.6%,P<0.001)。随访2年,家庭组BPRS、DAS量表分及再住院率均明显低于封闭组(P<0.05和0.01)。QOULI量表分明显高于封闭组(P<0.01)。结论:精神分裂症患者在药物控制症状的同时给予家庭干预更有利于精神分裂症患者精神症状的改善,降低社会残疾程度、改善社会功能、缩短住院时间和减少再住院率。     

Context of social awareness: prelude to social service

A required period of social service has recently been suggested as an addition to the medical school curriculum. The intent of this action is to improve the social sensitivity of physicians. If such a requirement is not placed within the appropriate context it may fail to achieve its objectives. Attention to institutional commitment, faculty experience, student selection, and supporting didactic materials are offered as suggestions to improve the utility of a social service requirement.     

Portrait of social work

Social work is concerned with enhancing the well-being of people within their social contexts. It is a broad profession with diverse practices. These range from a focus on the personal distress of individuals to the collective arrangements and social processes that influence the well-being of groups and communities. The unique contribution of social work to the caring professions is its broad contextualised approach to addressing human needs. Yet this breadth of scope also provides fertile ground for competing discourses within the profession. This paper provides an overview of the 'highly contested' nature of social work's goals, theories and methods of practice.     

Portrait of social work

Social work is concerned with enhancing the well-being of people within their social contexts. It is a broad profession with diverse practices. These range from a focus on the personal distress of individuals to the collective arrangements and social processes that influence the well-being of groups and communities. The unique contribution of social work to the caring professions is its broad contextualised approach to addressing human needs. Yet this breadth of scope also provides fertile ground for competing discourses within the profession. This paper provides an overview of the 'highly contested' nature of social work's goals, theories and methods of practice.     

An integrated model of social environment and social context for pediatric rehabilitation

This article considers the conceptualization and operationalization of “social environment” and “social context” with implications for research and practice with children and youth with impairments. We first discuss social environment and social context as constructs important for understanding interaction between external environmental qualities and the individual's experience. The article considers existing conceptualizations within psychological and sociological bodies of literature, research using these concepts, current developmental theories and issues in the understanding of environment and participation within rehabilitation science. We then describe a model that integrates a person-focused perspective with an environment-focused perspective and that outlines the mechanisms through which children/youth and social environment interact and transact. Finally, we consider the implications of the proposed model for research and clinical practice. This conceptual model directs researchers and practitioners toward interventions that will address the mechanisms of child–environment interaction and that will build capacity within both children and their social environments, including families, peers groups and communities. Health is created and lived by people within the settings of their everyday life; where they learn, work, play, and love [p.2].

• Implications for Rehabilitation

• Understanding how social environment and personal factors interact over time to affect the development of children/youth can influence the design of services for children and youth with impairments.

• The model described integrates the individual-focused and environment-focused perspectives and outlines the mechanisms of the ongoing reciprocal interaction between children/youth and their social environments: provision of opportunities, resources and supports and contextual processes of choice, active engagement and collaboration.

• Addressing these mechanisms could contribute to creating healthier environments in which all children, including children with impairments, have experiences that lead to positive developmental benefits.

     

Representations of the self in social phobia: Vulnerability to social threat

A revised Stroop color-naming task was used to test hypotheses derived from Beck's cognitive theory of anxiety disorders which proposes that social phobics are hypervigilant to social-evaluative threat cues. Color-naming latencies for social and physical threat words were compared to matched neutral words for both social phobics and individuals with panic disorder. As predicted, social phobics showed longer latencies for social threat words, and panickers had longer latencies for physical threat words. Latency for color-naming social threat words correlated with self-reported avoidance among social phobics. These results are consistent with Beck's notion of self-schemata which facilitate the processing of threat cues. Methodological issues and clinical implications are discussed.Portions of this paper were presented at the World Congress of Behaviour Therapy, Edinburgh, September 1988, and at the annual meeting of the Association for the Advancement of Behavior Therapy, Boston, November 1988.