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1.
目的探讨结构式团体心理治疗在精神分裂症康复期的应用。方法选取我院治疗的120例精神分裂症康复期患者,随机分为2组,对照组给予药物治疗和康复训练,实验组在药物治疗和康复训练基础上实施结构式团队心理治疗。观察比较2组治疗效果、社会功能评分、治疗依从性和自知力恢复程度。结果实验组治疗效果较对照组明显改善(P0.05);治疗前2组社会功能评分无显著性差异(P0.05),治疗后实验组社会功能评分较对照组明显降低,治疗依从性及自知能力恢复程度均明显高于对照组(P0.05)。结论针对精神分裂症康复期患者实施结构式团体心理治疗,明显提高治疗效果和治疗依从性,改善患者社会功能评分及自知力,临床值得推广应用。  相似文献   

2.
背景:许多社区精神分裂症患者服药不规律因而很容易频繁复发。目的:评估自我管理培训对社区慢性精神分裂症患者服药依从性和复发情况的影响。方法 :共纳入上海市城市和农村的社区慢性精神分裂症患者201例,随机分为常规治疗组(n=98)或自我管理干预组(n=103)。干预组接受为期6个月的每周一次自我管理技能培训,之后参加每月一次的加强小组会议,由社区卫生工作者检查患者的自我管理清单,共24个月。由两名单盲于患者治疗情况的精神科医生使用Morisky服药依从性量表评估患者服药依从性并采用自知力评估量表(Scale to Assess Unawareness of Mental Disorders,SAUMD)了解基线时和30个月后患者的自知力。总共194人(95.6%)完成研究。结果 :基线时两组间无显著差异,但在30个月后,干预组服药依从性比常规治疗组好,对疾病的自知力提高,自我报告使用抗精神病药物的剂量相对高。在随访30个月里,干预组103例患者中只有2例(1.9%)复发(即一次或多次住院),然而对照组98例患者中有14例(14.3%)复发(X2=8.83,p=0.003)。结论 :本研究样本量大、随访时间相对长、随机设计并采用单盲法评估,研究结果的说服力相对强。本研究发现自我管理干预后患者复发显著减少、服药依从性改善以及自知力提高。这些结果拓展了我们先前的研究发现,显示自我管理训练可以有效改善社区慢性精神分裂症患者的症状和社会功能。今后需要纳入成本效益分析研究,评估将自我管理干预扩大到其他更多社区的可行性。  相似文献   

3.
目的探讨社区康复训练对慢性精神分裂症患者的效果。方法选取我社区慢性精神分裂症患者92例,根据完全随机化原则将其分为对照组和干预组,每组各46例。其中对照组患者给予常规抗精神分裂症药物治疗,干预组在此基础上给予社区康复训练。6个月后观察比较两组患者阳性和阴性症状量表(PANSS)、自知力与治疗态度问卷(ITAQ)、社会功能缺陷筛选量表(SDSS)评分。结果两组患者干预前PANSS、ITAQ与SDSS评分比较,差异均无统计学意义(P0.05)。干预后,干预组PANSS阳性量表、阴性量表、一般精神病理量表评分及总分、ITAQ与SDSS评分改善情况均优于对照组;且与同组干预前比较,以上评分均明显改善,差异均具有统计学意义(P0.05);而对照组以上评分无明显变化,差异无统计学意义(P0.05)。结论社区康复训练可明显改善慢性精神分裂症患者的症状,增强患者自知力和社会功能,促进其康复。  相似文献   

4.
背景 认知矫正治疗(Cognitive Remediation Therapy,CRT)是一种很有希望的、新的非药物治疗方法,能够减少精神分裂症患者的认知缺损。但未在国内得到充分的验证。目的 探讨认知矫正治疗对慢性精神分裂症患者认知功能、社会功能及自知力的疗效。方法 将126例病情相对稳定的慢性精神分裂症住院患者随机分成干预组和对照组。干预组接受行认知矫正治疗,对照组接受常规的工娱治疗,两组在治疗频度和治疗持续时间一致,均为每周5次,共3个月。于治疗前及治疗末分别采用威斯康星卡片分类测验(Wisconsin Card Sorting Test,WCST)评估认知功能,采用住院慢性精神分裂症患者社会功能评定量表(Scale of Social Skills of chronic schizophrenia Inpatients,SSSI)评估社会功能以及采用自知力与治疗态度问卷(Insight and Treatment Attitude Questionnaire,ITAQ)评估自知力。结果 研究过程中有4例患者脱落,干预组60例、对照组62例最终进入结果分析。治疗3个月后,两组的WCST测评结果均较治疗前显著改善,而干预组的WCST各指标的改善均比对照组明显。两组在3个月治疗后的SSSI总分均显著改善,但改善程度在两组间无显著性差异;两组的ITAQ总分也均有提高,但干预组的改善程度比对照组更明显。结论 在药物治疗的基础上,为期3个月的认知矫正治疗对改善慢性精神分裂症住院患者的认知功能及自知力比常规的工娱治疗更为有效。  相似文献   

5.
早期心理干预对精神分裂症患者预后的影响   总被引:2,自引:1,他引:1  
目的探讨早期心理干预对精神分裂症患者预后的影响。方法将100例符合CCMD3精神分裂症诊断标准的患者随机分为研究组(50例),对照组(50例),研究组除常规治疗外,早期即给予心理干预,对照组仅给予常规治疗;疗程12周;观察两组病人在一般项目、服药依从性、自知力恢复及BPRS评分等方面的变化。结果早期心理干预能尽早地改善病人的睡眠、饮食、服药依从性,减少意外事件的发生率,促进病人自知力的早期恢复。结论早期心理治疗能加快精神分裂症病人的康复。  相似文献   

6.
精神分裂症病人服药依从性护理干预临床观察   总被引:2,自引:0,他引:2  
为探索影响精神分裂症病人服药依从性的相关因素,并寻找有效的干预措施,对北京回龙观医院住院157例精神分裂症病人分为干预组和对照组作对照观察。干预组采取护理干预措施,对照组应用常规药的治疗护理,比较两组影响病人药物治疗依从性因素的变化。结果:影响住院精神分裂症病人用药依从性的主要因素为自知力,幻觉妄想,药物不良反应,阴性症状。通过对精神分裂症病人采取干预措施,提高了病人药物治疗的依从性。提示,对精神分裂症病人进行护理干预是提高病人药物治疗依从性的有效措施。  相似文献   

7.
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。  相似文献   

8.
目的:分析复发住院精神分裂症患者经过常规药物治疗及药物合并心理社会干预后对药物依从的影响,探讨药物依从性预测指标。方法:纳入150例复发入院精神分裂症患者,其中常规药物治疗组80例,药物合并心理社会干预组70例,收集人口学及临床资料,并于基线及随访治疗3个月时采用阳性与阴性症状量表(PANSS)、个人与社会功能量表(PSP)、用药态度量表(DAI)、自知力问卷(SAI)分别评估患者精神症状、社会功能、服药态度及自知力。随访1年内未服用抗精神病药的时间没有超过1周定义为药物依从。结果:药物合并心理社会干预治疗组依从性高于常规药物治疗组(χ~2=20.56,P0.001);在随访治疗3个月时药物合并心理社会干预治疗组患者DAI、SAI评分高于常规药物治疗组(P均0.05);Logistic回归分析显示常规药物治疗组药物依从与否与基线SAI评分(β=0.225,P=0.19)及随访治疗3个月后DTI评分(β=0.302,P=0.4)相关联,药物合并心理社会干预组药物依从与否与基线SAI评分(β=0.264,P=0.027)相关联,与随访3个月时PSP冲动攻击行为得分(β=-1.031,P=0.027)相关联。结论:药物合并心理社会干预药物依从性更佳,良好的自知力及治疗早期较好的服药态度是常规药物治疗依从良好的预测指标,住院时良好的自知力、治疗早期较少的冲动攻击行为是药物合并心理社会干预药物依从良好的预测指标。  相似文献   

9.
目的:探讨病情回放性心理治疗对精神分裂症患者的疗效. 方法:100例精神分裂症患者随机分为回放组和对照组,每组50例.两组分别进行药物加病情回放治疗和单纯药物治疗.采用简明精神病评定量表(BPRS)、自知力与治疗态度问卷(ITAQ)及社会功能缺陷筛选量表(SDSS),于人院时、出院时和出院后1年对患者进行评估. 结果:治疗后两组BPRS、ITAQ评分、治疗依从性和社会功能均较治疗前有明显改善,但以回放组显著较好(P均<0.05或P<0.01);并维持至出院后1年仍显著优于对照组(P<0.01).入院时回放组和对照组SDSS评分分别为(10.7±1.3)分和(10.3±1.2)分,出院后1年分别为(4.2±0.8)分和(7.2±0.9)分,以回放组显著优于对照组(P<0.01);病情复发率和再住院率均以回放组显著较低(P<0.01). 结论:病情同放性心理治疗可提高精神分裂症患者的治疗依从性,改善自知力,降低复发率和再住院率,有益于患者社会功能的恢复.  相似文献   

10.
认知治疗对精神分裂症患者服药依从性的影响   总被引:3,自引:0,他引:3  
目的:探讨认知治疗对精神分裂症患者服药依从性的影响. 方法:将100例精神分裂症患者随机平分为干预组和对照组.均接受系统的抗精神病药治疗,干预组在此基础上进行认知治疗,而对照组仅限于一般健康教育,出院后随访1年.采用简明精神病评定量表(BPRS)、自知力与治疗态度问卷(ITAQ)、自拟服药依从性调查表,于治疗前、出院时、出院后6个月及1年分别各评定1次. 结果:两组BPRS、ITAQ、服药依从性和再次住院次数差异有显著性,均以干预组显著较好. 结论:认知治疗能有效提高精神分裂症患者服药依从性,降低复发率.  相似文献   

11.
目的观察长春西汀联合氟西汀治疗脑卒中后抑郁症的临床疗效,初步探讨其作用机制。方法选择临床确诊为脑卒中后抑郁症患者120例,采用随机对照方法,分为长春西汀联合氟西汀治疗组(观察组)与氟西汀治疗组(对照组),每组60例,疗程4周。治疗前及治疗2、4周后通过神经功能缺损评分(NIHSS)以及汉密尔顿抑郁量表(HAMD)评定疗效。采用荧光分光光度计法测定血清单胺类递质的水平。结果治疗2、4周末,观察组和对照组经HAMD及NIHSs评分比较,治疗前两组评分均下降(P〈0.05);且观察组低于对照组(P〈0.05)。观察组总体疗效优于对照组(P〈0.05)。治疗前两组血清NE、DA、5-HT含量差异无统计学意义;治疗2、4周末,与治疗前相比,两组血清NE、DA、5-HT含量均有升高(P〈0.05),且观察组高于对照组(P〈0.05)。在用药安全性上,两组中治疗前后均未出现明显不良事件。结论长春西汀联合氟西汀治疗脑卒中后抑郁症能显著提高脑卒中后抑郁症患者的疗效,且无明显不良反应。作用机制可能与提高血清单胺类神经递质水平有关。  相似文献   

12.
Late-onset Alzheimer's disease (LOAD) is an age-related neurodegenerative disorder characterized by gradual loss of synapses and neurons, but its pathogenesis remains to be clarified. Neurons live in an environment constituted by neurons themselves and glial cells. In this review, we propose that the neuronal degeneration in the AD brain is partially caused by diverse environmental factors. We first discuss various environmental stresses and the corresponding responses at different levels. Then we propose some mechanisms underlying the specific pathological changes, in particular, hypothalamic-pituitary adrenal axis dysfunction at the systemic level; cerebrovascular dysfunction, metal toxicity, glial activation, and Aβ toxicity at the intercellular level; and kinase-phosphatase imbalance and epigenetic modification at the intracellular level. Finally, we discuss the possibility of developing new strategies for the prevention and treatment of LOAD from the perspective of environmental stress. We conclude that environmental factors play a significant role in the development of LOAD through multiple pathological mechanisms.  相似文献   

13.
目的 评价齐拉西酮治疗精神分裂症的疗效和安全性.方法 选择90例精神分裂症患者随机分为齐拉西酮组(139.6±23.5)mg/d和利培酮组(5.8±0.6)mg/d,疗程为8周.采用阳性与阴性症状量表(PANSS)、临床总体印象量表(CGI- S)和不良反应症状量表(TESS),分别于入组时(基线)、治疗后第2、4、6、8周末分别评定疗效和不良反应.结果 两组PANSS总分、阳性症状分、一般病理分从第2周末起较治疗前下降(P<0.05);两组PANSS阴性症状分在第4周末起较治疗前下降(P<0.05);两组CGI-S总分第2周末开始各时点较治疗前下降(P<0.05);齐拉西酮组临床总有效率为75%,利培酮组为78.4%,两组间疗效差异无统计学意义(P>0.05).齐拉西酮组、利培酮组不良反应发生率分别为26.6%(12/45)和51.1%(23/45),差异有统计学意义(P<0.01);利培酮组体质量增加(1.1±1.3)kg,齐拉西酮组体质量减少(1.4±1.5)kg,在锥体外系有关的副反应、血细胞、肝功能、心电图异常及自主神经系统不良反应方面利培酮组明显高于齐拉西酮组,差异有统计学意义(P<0.01).结论 齐拉西酮对精神分裂症的疗效等同于利培酮,而不良反应全面优于利培酮.  相似文献   

14.
目的研究四合院式病区环境、半开放式管理与楼房病区封闭式管理对慢性住院精神分裂症患者生活质量影响。方法按入组标准随机抽取我院四合院式病区半开放管理住院精神分裂症患者80例,楼房病区封闭式管理50例。采用生活质量综合问卷(GQOLI)简明精神病评定量表(BPRS)、副反应量表(TESS)进行评定,然后对比研究。结果四合院式病区环境、半开放式管理中的慢性住院精神分裂症患者GQOLI评分显著高于对照组。结论四合院式病区环境、半开放式管理的住院精神分裂症患者生活质量高于楼房病区环境封闭式管理。  相似文献   

15.
目的 探讨北京社区老年慢性病患者的睡眠质量及其影响因素.方法 采用整群随机抽样筛查的方法抽取调查对象,运用自填式问卷调查方式对213例社区老年慢性病患者进行调查,问卷包括调查对象基本情况问卷、简易精神状况检查表(MMSE)及匹兹堡睡眠质量指数量表(PSQI).结果 患1种慢性病的例数为93例(43.7%),患2种慢性病的为51例(23.9%),患3种及以上慢性病的为69例(32.4%).所有慢性病中,高血压所占比例最高(60.6%),病程最长.PSQI总分为(4.70±3.06)分,15.5%被调查者睡眠质量差.慢性病数量影响睡眠质量,慢性病越多睡眠质量越差.Logistic回归分析发现,生活自理能力、是否有配偶和是否参加运动与是否存在睡眠问题有关.结论 北京社区老年慢性病患者睡眠质量的影响因素较多,对老年慢性病群体的重视程度应逐步增大,应进一步深入和完善相关研究.  相似文献   

16.
标准外伤大骨瓣开颅术治疗重型颅脑损伤45例临床分析   总被引:2,自引:0,他引:2  
目的介绍采用标准外伤大骨瓣开颅术救治重型颅脑损伤患者的经验与治疗体会。方法回顾性分析采用标准外伤大骨瓣开颅术救治45例重型颅脑损伤的疗效。结果45例重型颅脑损伤患者中,根据GOS评分,恢复良好20例(44.4%),中残7例(15.5%),重残4例(8.9%),植物状态2例(4.4%),死亡12例(26.7%)。直接死亡原因:原发脑干损伤并发脑内血肿8例,慢性全身衰竭2例,多器官功能衰竭2例。结论对重型颅脑损伤患者采用标准外伤大骨瓣开颅术,尽早清除颅内血肿,大骨瓣减压,直视下脑疝复位可显著改善患者的预后。标准外伤大骨瓣开颅术是治疗重型颅脑损伤合并严重脑挫裂伤、大面积脑水肿颅内高压患者的一种有效的手术方式。  相似文献   

17.
高血压脑出血(Hypertensive intrac-rebral hemorrhage,HICH)是具有高发病率、高病死率、高致残率的急性脑血管疾病,占所有脑卒中患者的10%-20%,早期病死率可高达49.4%。随着人口老龄化,其发病率逐年提高;而外科手术的干预,使其病死率有所下降,但致残率居高不下。如何提高手术疗效和患者生存质量,一直是神经外科医师努力的方向。微侵袭血肿清除术因其手术创伤小,恢复快,是目前国内治疗高血压脑出血的重要手段。  相似文献   

18.
BACKGROUND: Previous studies of cerebral ischemia have used young animals, with an ischemic time greater than 5 minutes (safe time limit). Despite an increased understanding of neuronal apoptosis, it remains uncertain whether brief cerebral ischemic events of 5 minutes or less damage brain tissue in elderly rodents. OBJECTIVE: To investigate the effects of transient cerebral ischemia (5 minutes)/reperfusion injury on brain cortical and hippocampal edema, aquaporin-4 (AQP-4) expression, and neuronal apoptosis in aged rats, and to compare ischemic sensitivity between cortex and hippocampus. DESIGN, TIME AND SETTING: A randomized, controlled, animal experiment was performed at the Institute of Cerebrovascular Disease, Qingdao University Medical School from April 2008 to March 2009. MATERIALS: Rabbit anti-AQP-4 polyclonal antibody, TUNEL kit, and SABC immunohistochemistry kit were purchased from Wuhan Boster Bioengineering, China. METHODS: A total of 160 healthy, male, aged 19-21 months, Wistar rats were randomly assigned to 4 groups: sham-surgery, and ischemia 1-, 3-, and 5-minute groups, with 40 rats in each group. The global cerebral ischemia model was established using the Pusinelli four-vessel occlusion, and the three cerebral ischemia groups were subdivided into reperfusion 12-hour, 1-, 2-, 3-, and 7-day subgroups, with 8 rats in each subgroup. The sham-surgery group was subjected to exposure of the first cervical bilateral alar foramina and bilateral common carotid arteries. MAIN OUTCOME MEASURES: The dry-wet weight assay was used to measure brain water content and histopathology of the cortex and hippocampus was observed following hematoxylin-eosin staining. In addition, cortical and hippocampal AQP-4 expression was detected by streptavidin-biotin complex immunohistochemistry, and neuronal apoptosis was detected by the TUNEL method. RESULTS: There was no significant difference in brain water content or AQP-4 expression in the cortex and hippocampus between ischemia 1- and 3-minute groups and the sham-surgery group or brain water content or AQP-4 expression in the cortex between ischemia 5-minute group and sham-surgery group (P 〉 0.05). However, brain water content and AQP-4 expression in the hippocampus after 5 minutes of cerebral ischemia were significantly increased compared with the sham-surgery group (P 〈 0.05 or P 〈 0.01). Several TUNEL-positive cells were observed in the cortex and hippocampus of the sham-surgery group and ischemia 1-minute group, as well as in the cortex of the ischemia 3-minute group. In addition, the number of apoptotic neurons in the hippocampus of ischemia 3-minute group and in the cortex and hippocampus of ischemia 5-minute group was significantly increased (P 〈 0.05 or P 〈 0.01 ). Neuronal apoptosis was increased after 12 hours of ischemia/reperfusion, and it reached a peak by 2 days (P 〈 0.01). CONCLUSION: Transient cerebral ischemia (5 minutes) resulted in increased hippocampal edema, AQP-4 expression, and neuronal apoptosis. Moreover, cerebral ischemia had a greater effect on neuronal apoptosis than brain edema or AQP-4 expression, and the hippocampus was more sensitive than the cortex.  相似文献   

19.
目的 探讨神经内镜联合亚低温在治疗高血压基底节区脑出血中的临床应用价值.方法 回顾性分析我院神经内镜治疗高血压基底节区脑出血患者40例的临床资料,并对治疗结果进行分析.结果 神经内镜治疗组22例(甲组),神经内镜联合亚低温治疗组18例(乙组),术后3个月根据GCS评分,甲组恢复良好1例,中残4例,重残6例,植物生存6例,死亡5例;乙组恢复良好4例,中残8例,重残3例,植物生存1例,死亡2例,两组比较差异有统计学意义(P<0.05).两组颅内压比较第1天两者差异不明显,但第2、3天亚低温组颅内压明显降低.结论 神经内镜是治疗高血压基底节区脑出血较为有效的手术方式,联合亚低温治疗能有效降低颅内压,改善术后神经功能恢复,具有较好的临床应用价值.  相似文献   

20.
BACKGROUND: Total saponins of Panax ginseng (TSPG) exhibits neuroprotection against Parkinson's disease in the substantia nigra. OBJECTIVE: To investigate the effects of TSPG on human embryonic neural stem cells (NSCs) proliferation and differentiation into dopaminergic neurons using in vitro studies, and to observe NSC differentiation in a mouse model of Parkinson's disease, as well as behavioral changes before and after transplantation. DESIGN, TIME AND SETTING: In vitro neural cell biology trial and in vivo randomized, controlled animal trial were performed at the Institute of Basic Medical Sciences, Chongqing Medical University between September 2004 and December 2007. MATERIALS: TSPG (purity 〉 95%) was isolated, extracted, and identified by Chongqing Academy of Chinese Materia Medica. Recombinant human basic fibroblast growth factor (bFGF) and recombinant human epidermal growth factor (EGF) were purchased from PeproTech, USA. A total of 25 C57/BL6J mice, aged 18-20 weeks were included. Twenty were used to establish a Parkinson's disease model with i.p. injection of MPTP (1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine) and TSPG alone or combined with interleukin-1 (IL-1)-treated NSCs prior to transplantation into the corpus striatum. The remaining five mice were pretreated for 3 days with TSPG prior to MPTP injection, serving as the TSPG prevention group. METHODS: Primary NSCs were isolated, cultured and purified from embryonic cerebral cortex. Immunocytochemistry was employed to detect specific antigen expression in the NSCs. In vitro experiment: (1) to induce proliferation, NSCs were treated with TSPG, EGF+bFGF, or TSPG+EGF+bFGF, respectively; (2) to induce dopaminergic neuronal differentiation, NSCs were treated with TSPG, IL-1, or TSPG+IL-1, respectively. MAIN OUTCOME MEASURES: In vitro experiment: the effects of TSPG on NSCs proliferation were evaluated with flow cytometry and MTT assay. Tyrosine hydroxylase expression was determined by immunocytochemistry assay to observe effects of TSPG on dopaminergic neuronal differentiation. In vivo experiment: differentiation of grafted NSCs in the mouse brain was determined by immunohistochemical staining. Behavioral changes were evaluated by spontaneous activity frequency, memory function, and score of paralysis agitans. RESULTS: (1) NSCs were cultured and passaged for more than three passages. Immunocytochemistry revealed positive nestin staining, as well as neurofilament protein and glial fibrillary acidic protein. (2) TSPG significantly increased NSC proliferation, in particular when combined with EGF and bFGF, which was twice as effective as FGF or bFGF alone. TSPG also induced dopaminergic differentiation in NSCs, in particular when TSPG was added together with IL-1, resulting in an effect five times greater than that of IL-1 alone. (3) At day 30 following transplantation, most NSCs in the TSPG prevention group differentiated into dopaminergic neurons, and the scores of paralysis agitans, spontaneous activity, and memory function were significantly increased compared with TSPG alone or TSPG+IL-1 groups (P 〈 0.05). CONCLUSION: TSPG stimulated NSC proliferation, in particular when combined with FGF and bFGF. TSPG significantly induced dopaminergic neuronal differentiation of NSCs, and the effect was greater when combined with IL-1. In addition, TSPG greatly improved behavior in the Parkinson's disease mouse model following NSC transplantation. Following NSC transplantation, TSPG pretreatment exhibited superior efficacy over either TSPG alone or TSPG in combination with IL-1, in terms of behavioral improvements in the Parkinson's disease mouse model.  相似文献   

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