综合干预对农村精神分裂症患者预后的影响

目的 探讨生物-心理-社会综合干预对农村社区精神分裂症患者预后的影响。方法 将符合入组标准的300例农村社区精神分裂症患者分为干撷组和对照组(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<300 mg/d),其中干预组同时接受生物-心理-社会综合干预及个案管理;于入组时和随访每半年时评定1次社会功能缺陷筛选量表(SDSS)、简明精神病评定量表(BPRS)、疾病严重程度量表(SI)、疾病总体进步量表(GI),3年共7次。结果 (1)入组时干预组与对照组相比,BPRS、SI、GI、SDSS评分的差异均无显著性(P>0.05);(2)综合干预1年时,干预组各量表的评分均低于对照组,差异有显著性(均P<0.01),并持续到随访结束。(3)随访结束时,干预组在掌握精神卫生知识、规律就医、接受精神科治疗、恢复工作能力等方面均好于对照组(均P<0.01)。结论 生物-心理-社会综合干预使农村社区精神分裂症患者的复发率明显降低。     

家庭护理干预对稳定精神分裂症患者病情的影响

目的 探讨家庭护理干预对稳定精神分裂症患者病情的影响.方法 对临床痊愈出院的精神分裂症263例随机分为研究组(132)例和对照组(131)例,出院后2组均给予抗精神病药物维持治疗和护理,研究组在此基础上实施家庭护理干预,观察一年.采用简明精神病评定量表(BPRS)、服药依从量表于入组时、3个月、6个月、1年后进行评定.结果 1年后,研究组BPRS总分、服药依从性明显好于对照组,差异有显著性(P<0.01);研究组的复发率(21.9%)低于对照组(33.5%),差异有显著性(χ2=3.95,P<0.05).结论 家庭护理干预对稳定精神分裂症患者病情有重要意义.     

综合干预对农村精神分裂症患者家庭环境的影响

目的 探讨生物-心理-社会综合干预措施对农村精神分裂症患者家庭环境、情感表达的影响。方法 将符合入组条件的300例患者分为干预组和对照组,每组各150例。两组均服用小剂量抗精神病药(折合氯丙嗪剂量为<300 mg/d),共3年;同时对干预组实施生物-心理-社会综合干预。于入组时和随访时(每半年评定1次,共7次)对患者评定家庭环境量表、坎伯威家庭问卷和家庭会谈量表。结果(1)入组时,两组患者家庭环境及家庭负担的差异均无显著性;干预组家属热情性和赞扬性因子分高于对照组(P<0.05)。(2)研究结束时,干预组患者的情感表达和矛盾因子分低于对照组(P<0.01),亲密度、独立性、成功性、文化性、娱乐性、组织性和道德性等因子分均高于对照组(均P<0.01-0.05),对其家庭娱乐影响、对家人的躯体健康、心理健康影响及家庭负担总分均低于对照组(P<0.01)。干预组家属的批评、敌对和情感参与等因子分低于对照组(P<0.05～0.01),热情性、赞扬性等因子分高于对照组(P<0.01)。结论 生物-心理-社会综合干预方法对农村精神分裂症患者能有效地改善家庭环境、降低照料者的情感表达,并减低患者的疾病严重程度。     

不同干预方式对慢性精神分裂症患者生活质量和康复影响的研究

目的探讨不同干预方式对慢性精神分裂症患者生活质量和康复的影响。方法将180例慢性精神分裂症患者随机分成研究组和对照组各90例。对照组进行药物干预,研究组在药物干预基础上进行社区随访干预。所有患者均评定简明精神量表(BPRS)、生活质量综合评定问卷-74(GQOLI-74)和自知力与治疗态度问卷(ITAQ),并评定康复效果和冲动暴力行为发生率。结果 12个月后,研究组BPRS评分低于对照组(P<0.01);研究组GQOLI-74心理健康和社会功能因子评分高于对照组(P<0.01);研究组ITAQ评分高于对照组(P<0.05)。结论社区随访干预能显著改善慢性精神分裂症患者的生活质量和康复效果。     

文拉法辛合并舒必利治疗精神分裂症对照研究

目的:探讨文拉法辛合并舒必利治疗精神分裂症的疗效和安全性。方法:将68例精神分裂症患者随机分为研究组与对照组,研究组给予文拉法辛合并舒必利治疗,对照组用利培酮治疗,疗程8周,用阳性与阴性症状量表(PANSS)、简明精神病评定量表(BPRS)以及治疗中出现的症状量表(TESS)评定疗效和安全性。结果:治疗8周研究组总有效率为88.24%,对照组为67.65%,两组比较差异有统计学意义(P<0.05)。治疗后两组PANSS及BPRS评分均有明显下降(P<0.05或P<0.01),研究组下降更显著(P<0.05)。结论:文拉法辛合并舒必利治疗精神分裂症阴性与阳性症状疗效可靠,不良反应小。     

系统干预对康复期精神分裂症患者症状和社会功能改善的对照研究

目的 探讨系统干预对康复期精神分裂症患者症状和社会功能改善的影响.方法 将282例康复期精神分裂症患者随机分成研究组和对照组,对研究组患者进行有针对性的系统干预,而对照组只给予一般性随访,共干预1年.在基线及干预后采用阳性与阴性症状量表(PANSS)、社会功能缺陷筛选量表(SDSS)及副反应量表(TESS)进行效果评定.结果 干预后,研究组PANSS和SDSS的各因子分及总分均显著低于对照组(P＜0.05),研究组SDSS总分较基线时显著降低(P<0.05),而PANSS的各因子分和总分无明显变化(P>0.05).干预后的研究组中,使用非典型杭精神病药物患者的PANSS和SDSS各因子分及总分均显著低于使用典型杭精神病药物者(P<0.05).研究组不良反应发生率显著低于对照组(P<0.05).结论 系统干预可有效改善康复期精神分裂症患者的症状和社会功能,非典型抗精神病药亦有助于改善患者的症状和社会功能.     

家庭护理干预对精神分裂症患者康复的影响

目的 探讨家庭护理干预对精神分裂症患者康复的影响.方法 将163例精神分裂症患者随机分为2组,均于干预前和8周末采用简明精神病症状量表(BPRS)、自知力与治疗态度问卷(ITAQ)、社会功能筛选量表(SDSS)进行评价比较.结果 2组入组时各量表评分比较差异无统计学意义(P＞0.05).干预8周末研究组BPRS总分及焦虑抑郁和缺乏活力因子分均明显低于对照组,差异有统计学意义(P＜0.05);ITAQ评分研究组为(17.24±0.48),对照组为(9.56±0.42),2组差异有统计学意义(P＜0.01);SDSS总分及各因子分均明显高于对照组,2组差异有统计学意义(P＜0.01).结论 家庭护理可有效促进精神分裂症患者康复.     

临床护理路径对长期住院精神分裂症患者康复的影响

目的探讨临床护理路径对长期住院精神分裂症患者症状和日常生活能力的影响。方法将我院住院时间5年以上的78名精神分裂症患者随机分成研究组(39例)和对照组(39例),对研究组执行临床护理路径,对照组仅给予常规护理。采用简明精神病评定量表(BPRS)及日常生活能力量表(ADL),对两组患者分别于入组时及入组第3、6、12个月末进行评定。结果研究后第3个月末起研究组ADL量表评分低于对照组(P0.01)。研究后第6个月末起研究组BPRS量表评分低于对照组(P0.01)。结论临床护理路径能够改善长期住院精神分裂症患者的症状和日常生活能力。     

"异性效应"对首发精神分裂症住院患者的康复效果

目的 探讨"异性效应"对首发精神分裂症住院患者康复效果的影响.方法 将227例首发精神分裂症患者随机分为研究组114例(男女混合病区)和对照组113例(男性入住男病区/女性入住女病区),均采用利培酮2～6 mg/d治疗6～8周.入组前和治疗2、6、8周末均进行阳性与阴性症状量表(PANSS)、简明精神病评定量表(BPRS)和社会功能缺陷筛选量表(SDSS)的评定及长期风险评估.结果 ①治疗2周末,两组BPRS、PANSS和SDSS评分较入组时均明显减少,而研究组阳性症状、一般病理性症状和SDSS评分明显低于对照组,上述差异均有统计学意义(P＜0.05～0.01);②治疗6、8周末,研究组BPRS、PANsS和SDSS总分值明显低于对照组,差异均有统计学意义(P＜0.05～0.01);③出院时两组总有效率研究组为86.8%,对照组为82.2%,差异无统计学意义(P＞0.05),但研究组住院天数[(48.28±21.11)d]较对照组[(57.84±28.84)d]显著缩短(P＜0.01);④在风险方面,打架、不服从管理、不配合治疗、同性恋、手淫、对异性行为举止轻率等方面,研究组明显低于对照组(P＜0.001);在性骚扰、亲昵举动等性问题方面研究组的发生率明显多于对照组(P＜0.01～0.001).结论 "异性效应"作用能够较早缓解患者的精神症状,缩短住院时间,减少社会功能缺陷.在加强风险管理的力度下,首发精神分裂症患者男女混合住院治疗的管理模式值得推广.     

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。     

Patient and relative education in community psychiatry: a randomized controlled trial regarding its effectiveness

Background: Family psychoeducation has a well-documented effect on the short-term prognosis in schizophrenia. Less is known about the effectiveness of shorter programmes with the main focus on information for patients (patient education) or for patients and relatives (family education). Methods: A randomized study of the effectiveness of an eight-session psychoeducational programme for patients with schizophrenia and for their relatives was conducted in two community mental health centres, in Århus and Viborg (Denmark). Patient outcome measures were knowledge, relapse, compliance, insight and satisfaction, and relative outcome measures were knowledge and satisfaction. Postintervention outcome and follow-up evaluation 1 year after the start of the intervention are presented. Results: A statistically significant increase in knowledge of schizophrenia in both relatives and patients was demonstrated at postintervention and a non-significant trend at 1-year follow-up. Statistically significant changes in the Verona Service Satisfaction Scale Scores in the sub-dimension of satisfaction with Relatives involvement were demonstrated both for patients and relatives postintervention and for patients at 1-year follow-up. There was a tendency that time-to-relapse increased in the intervention group at postintervention and that the schizophrenia subscore of the Brief Psychiatric Rating Scale was reduced in the intervention group at 1-year follow-up. No differences were found between the groups regarding compliance, insight into psychosis, psychosocial function (General Assessment of Function) or in relatives' expressed emotion scores postintervention or at 1-year follow-up. Conclusion: A short patient and relative education programme seems to be able to influence knowledge and some aspects of satisfaction, but does not seem to be sufficient to influence important variables such as relapse, compliance, psychopathology, insight or psychosocial functioning.     

Attentional-shaping as a means to improve emotion perception deficits in schizophrenia

Inability to recognize emotional expressions of others (emotion perception) is one of the most common impairments observed among individuals with schizophrenia. Such deficits presumably contribute much to the social dysfunction characteristic of schizophrenia. This study examined the efficacy of a novel attentional-shaping intervention to improve emotion perception abilities. Sixty participants with schizophrenia were randomly assigned to one of three intervention conditions: 1) attentional-shaping, 2) contingent monetary reinforcement, or 3) repeated practice. Participants completed the Face Emotion Identification Test (FEIT) at pre-test, intervention, post-test, and one week follow-up. Participants also completed the Bell-Lysaker Emotion Recognition Test (BLERT) and the Social Behavior Scale at pre-test and follow-up to measure generalization. The results showed that the attentional-shaping condition had significantly higher scores on the FEIT at intervention, post-test, and follow-up compared to monetary reinforcement and repeated practice. Improvement was also found on the BLERT and a trend was found for improved social behaviors at one-week follow-up. Results will be discussed in terms of face scanning and attentional deficits present in schizophrenia and potential uses of this intervention in the remediation of emotion perception deficits.     

Employment outcome and predictors of competitive employment at 2-year follow-up of a vocational rehabilitation programme for individuals with schizophrenia in a high-income welfare society

Background: Employment is an important part of recovery for individuals with schizophrenia. The employment rate for this group is as low as 10% in Norway, and major system related barriers to employment are evident.

Aims: This study reports the competitive employment outcome at 2-year follow-up of a vocational rehabilitation study augmented with cognitive remediation (CR) or elements from cognitive behaviour therapy (CBT) for individuals with schizophrenia spectrum disorders. It also investigates if global functioning, self-esteem, and depression at baseline predicts employment outcome, and if change in these variables during the intervention period is associated with employment outcome.

Method: One hundred and forty-eight participants with schizophrenia spectrum disorders in six Norwegian counties received 10 months vocational rehabilitation augmented with either CBT (n?=?84) or CR (n?=?64). Both competitive and sheltered workplaces were used. Participants were assessed at baseline, at the end of the intervention period, and at 2-year follow-up.

Results: At 2-year follow-up, 21.2% had obtained competitive employment. A further 25.3% had work placements in competitive workplaces. Significant improvements were found in global functioning, self-esteem, and depression during the intervention period, but no significant differences between the two intervention groups. High baseline global functioning and self-esteem, as well as positive change in these variables during the intervention period, were significantly associated with higher competitive employment outcome at 2-year follow-up.

Conclusion: The results add to existing evidence that competitive employment is attainable for individuals with schizophrenia. High global functioning and self-esteem were strongly associated with competitive employment outcome.     

Modification of affect perception deficits in schizophrenia

This study investigated two strategies for improving facial affect perception in schizophrenia: monetary reinforcement and promoting facial feedback via mimicry of the expressions of target faces. A total of 40 inpatients with schizophrenia were administered the face emotion identification test during four phases: baseline, intervention, immediate post-test, and 1week follow-up. Subjects were randomly assigned to one of four interventions: repeated practice, monetary reinforcement, facial feedback, and a combination of reinforcement and facial feedback. Generalization of the intervention to a test of facial affect discrimination was also examined. The results showed that all groups of subjects, with the exception of those in the repeated practice group, improved in their ability to identify facial affect, with these effects showing some stability over time. There was limited evidence of these effects generalizing to the test of facial affect discrimination.     

Multi-modal weight control intervention for people with persistent mental disorders

Obesity, a major problem worldwide, is more prevalent among people with schizophrenia. This study examined the effect of behavior intervention, nutritional information and physical exercise on the body mass index (BMI) and weight of people who were hospitalized with persistent DSM-IV schizophrenia and schizoaffective disorders. Fifty nine inpatients with a BMI greater than 25 participated, (28 intervention group; 31 control group). Significant reductions in BMI and weight were observed in the intervention group after 3 months and were maintained 1-year post study [F(1,52) = 6.1, p = .017) and F(1,52) = 3.7, P = .006, respectively]. If provided with adequate information and an appropriate framework, people with persistent schizophrenia can significantly reduce BMI and weight and maintain the loss.     

Anthropology and Genetics

Objectives: The long-term outcomes of several approaches to intervention targeting social functioning in schizophrenia are not well documented. Contemporary supportive psychodynamic psychotherapy (SPP) aims to improve social functioning. The aim of the present study was to investigate the long-term outcome of SPP in a prospective, longitudinal, comparative, multicenter investigation of successively referred patients diagnosed with first-episode schizophrenia spectrum disorder.

Method: Manualized SPP for up to 3 years as a supplement to standard treatment (ST) were compared to ST alone and followed up for 5 years (N = 269). The SPP targeted interpersonal relationships, emotion regulation, social cognition, and self-coherence.

Results: Significant between-group effects in favor of SPP+ST on social functioning, overall symptoms, and positive psychotic symptoms were found during the period of active SPP intervention. These differential effects, however, were not sustained after end of additional SPP at 5-year follow-up.

Conclusion: The findings are in line with results from other approaches targeting social functioning in schizophrenia and support SPP as a valuable treatment. Further research into the curative elements of SPP is needed.     

The effect of family intervention on chronic schizophrenics under individual psychosocial treatment: a 3-year study

  Background: The effectiveness of family intervention in schizophrenia has mainly been tested by controlled trials which recruited patients after hospital discharge. Less is known about its effectiveness when chronic schizophrenics displaying negative rather than positive symptoms are engaged in treatment. This study was conducted in two community-based rehabilitation units for chronic psychiatric patients and was planned to test: (1) whether family intervention combined with individual psychosocial treatment is more effective than individual psychosocial treatment in improving the clinical and social prognosis of schizophrenic patients belonging to high expressed emotion (high-EE) families, and (2) whether family intervention exerts its effect on the patients through the reduction of EE in their families. Methods: Forty patients from high-EE families, all under neuroleptic medication and in remission at intake, were evenly assigned to individual psychosocial treatment or to psychoeducational family intervention plus individual psychosocial treatment. Individual treatment consisted of vocational and social skills training; family intervention mainly comprised 13 group sessions with relatives. Patients were treated for 12 months and were followed-up for the next 2 years. Measures of clinical outcome comprised relapse, hospitalization and clinical exacerbation. Measures of social outcome included social functioning and role performance. Re-employment served as an additional measure at the follow-up assessments. Results: The experimentals were free of relapses and hospitalizations during the 1st year of follow-up. The difference in relapse rates between experimentals and controls over the same period was statistically significant (P = 0.05), especially if drop-outs were included in the statistical analysis. The difference in hospitalization rates did not yield any statistical significance. All differences declined in the 2nd year of follow-up. Family intervention was found to be positively, but not significantly, associated with higher reversal rates from high to low EE, especially among full attenders of relatives' group sessions. High EE was identified as a predictor of relapse, but not of hospitalization, over the 2-year follow-up period. Conclusion: Results support the importance of encompassing family members in the community care and tertiary prevention of schizophrenia. Accepted: 21 August 2000     

Insight into schizophrenia: the effects of cognitive behavioural therapy on the components of insight and association with sociodemographics--data on a previously published randomised controlled trial

Insight in schizophrenia is an evolving concept with widespread use in clinical practice. Results are presented from a multicentre randomised trial in which patients with schizophrenia and carers received a short insight-focused Cognitive Behaviour Therapy (CBT) intervention from trained nurses in the community. The CBT group demonstrated significantly greater improvement in insight into compliance with treatment and the ability to re-label their psychotic symptoms as pathological compared with the control group at post-therapy assessment. Those participants who demonstrated improved insight into having a mental illness tended to become depressed. At the end of therapy and at 1-year follow-up, there was a statistically significantly increased dropout rate in African-Caribbean and Black African participants. The Black Caribbean group showed a significantly smaller change in insight compared to the white group. At 1-year follow-up, the result on total insight and compliance was durable. The change in insight in the Black African group was significantly lower compared to the white group. The study emphasizes the role of a short insight-focused CBT intervention in improving patients' insight into compliance and its implications. The results confirm previous findings of difficulties in engaging patients of Afro-Caribbean origin and their poor response to psychological therapies as currently delivered.