开发式工娱疗法对慢性精神分裂症的疗效分析

慢性精神分裂症在进行常规药物治疗的同时,结合工娱疗法,以SANS、BPRS及NORS量表为评定指标,对46例患进行了一年观察,三种量表评分均有明显下降,疗效明显优于对照组。对阳性症状已消失而阴性症状迁延的患尤为显效。     

工娱疗合并舒必利治疗精神分裂症阴性症状的对照研究

目的 探讨工娱疗合并舒必利对精神分裂症阴性症状的治疗康复作用。方法 将60例以阴性症状为主的精神分裂症患者随机分成两组,进行为期8周的对照研究,分别用工娱疗合并舒必利（研究组）和舒必利（对照组）治疗;采用BPRS、SANS、SAPS和临床疗效评定标准进行评定。结果 研究组在治疗后4周、8周末SANS评分较治疗前均有显著性差异。对照组仅在治疗后8周时SANS评分较疗前显著性差异。两组在治疗后4周,8周时SANS减分均数比较均有非常显著性差异（P＜0．01）。结论 工娱疗合并舒必利对精神分裂症阴性症状的疗效优于单用舒必利,且起效快。     

工娱治疗对慢性精神分裂症患者康复效果的对照研究

目的探讨工娱治疗对慢性精神分裂症患者康复效果的影响。方法选取符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)慢性精神分裂症诊断标准的患者,共100例。采用随机数字表法分为研究组和对照组,各50例。两组均使用抗精神病药物,研究组辅以12周的工娱治疗。分别于治疗前后采用阴性症状量表(SANS)、护士用住院病人观察量表(NOSIE)及世界卫生组织生活质量表(WHOQOL-100)对两组进行评定。结果治疗后研究组SANS总分及各因子分均下降(P均0.01);NOSIE总分及消极因素分下降而积极因素分上升(P均0.01);生活质量表评定除心理领域、精神支柱外,其它各领域评分均明显提高(P均0.01);而对照组各项评分均无明显变化。结论工娱治疗对慢性精神分裂症有明显疗效,有利于改善精神分裂症患者的生活质量,有利于患者重返社会。     

阳性强化法在慢性精神分裂症患者工娱治疗中的应用

目的：探讨阳性强化法在慢性精神分裂症患者工娱治疗中的作用。方法：将100例慢性精神分裂症患者随机分为研究组（51例）和对照组（49例）,在维持原有抗精神病药治疗基础上,分别给予工娱治疗＋阳性强化疗法和工娱治疗3个月,于治疗前和治疗1个月、3个月护士用住院病人观察量表（NOSIE）及阳性与阴性症状量表（PANSS）进行评定分析。结果：两组治疗前NOSIE及PANSS评分差异均无统计学意义（P均〉0.05）;治疗3个月NOSIE中社会能力、社会兴趣、个人整洁、激惹因子评分和PANSS中阴性症状和精神病理因子评分,两组比较差异均有统计学意义（P〈0.05或P〈0.01）。结论：在工娱治疗时应用阳性强化法能明显提高治疗效果,改善患者的社会功能,提高其生活质量。     

工娱治疗对慢性精神分裂症患者疗效的影响

目的　为研究工娱治疗对慢性精神分裂症患者的辅助治疗作用。方法　63 例慢性精神分裂症患者随机分为两组,在治疗前及治疗后对每位患者采用SANS评定,两组患者均维持原精神病药物治疗不变;工娱治疗组(n=31)辅助实施工娱治疗,对照组只用药物治疗,观察 8 周。结果　两组治疗前后 SANS评分均有显著差异(P<0.05);工娱治疗组疗效优于对照组(P<0.01)。结论　工娱治疗对慢性精神分裂症患者是一项有效的辅助治疗措施。症状,提高慢性精神分裂症患者生活质量的结果基本一致。工娱治疗是通过工作、劳动、娱乐、文体活动以转移患者对病态体验的注意力,从而减少和消除精神症状,改善情绪,增强体质,建立生活信心,提高适应外界环境的能力,促进疾病痊愈或康复,防止精神衰退[4]。而适当的工娱治疗使患者能与周围环境、人群保持接触,帮助患者大脑功能朝正常方面发展,对减轻精神症状,防止精神衰退,恢复社会技能,提高生活质量等起重要作用[5]。总之,工娱治疗对精神分裂症尤其是慢性精神分裂症患者是一项有效的辅助防治措施。     

工娱治疗对精神分裂症康复的影响

目的　观察工娱治疗对精神分裂症的治疗效果。方法　住院的慢性精神分裂症和急性症状控制后的精神分裂症病人 98例 ,随机分为工娱治疗组和对照组各 4 9人 ,观察 8周 ,以BPRS和SANS量表评定疗效。结果　两组患者BPRS和SANS评分差异均有显著性 (P<0 .0 1)。结论　工娱治疗对精神分裂症病人的康复有明显疗效。     

工娱治疗对精神分裂症患者生活质量的影响

本研究旨在探讨工娱治疗对长期住院的精神分裂症患者生活质量的影响.1 对象和方法所有病例均为我院精神科住院患者.符合中国精神疾病分类方案与诊断标准第2版修订本慢性精神分裂症诊断标准;以阴性症状为主,阴性症状量表(SANS)≥50分;病程>5年,住院时间>1年;简明精神病评定量表(BPRS)≥25分;能参与工娱疗活动.     

工娱治疗对慢性精神分裂症患者社会功能康复的作用

慢性精神分裂症患者的社会功能康复是精神卫生工作者研究的重要课题之一。为此,本文探讨了工娱治疗对慢性精神分裂症患者的社会康复作用,现将结果报告如下：     

氯氮平合并碳酸锂治疗慢性精神分裂症的临床对照研究

精神分裂症是精神科常见病之一,迄今病因尚未明了,慢性化和致残率很高。到目前为止,临床应用的抗精神病药有50余种,但对反复发作的慢性精神分裂症仍收效甚微。我们在临床工作中发现,氯氮平合并碳酸锂治疗慢性精神分裂症可收到一定的效果。故设计该课题进行研究,以观察其疗效及安全性。1 对象与方法1.1 对象 为2001年2月～10月住我院的精神分裂症患者。1.1.1 入组标准 (1)符合CCMD-2-R精神分裂症残留期或衰退期的诊断标准;(2)总病程≥5年;(3)年龄在18～50     

维思通与氯氮平治疗慢性精神分裂症的临床对照研究

目的 探讨维思通和氯氮平治疗慢性精神分裂症的临床疗效及副反应。方法 对９６例符合ＣＣＭＤ－２－Ｒ中精神分裂症诊断标准,病程≥５年,ＰＡＮＳＳ总分≥６０分的住院患者并随机分为维思通组（ｎ＝５１例）和氯氮平组（ｎ＝４５例）。研究期限为９周。两组均采用药物固定剂量法,维思通组每日４ｍｇ,氯氮平组每日３７５ｍｇ。分别于研究前、后评定两次ＰＡＮＳＳ量表。以研究前后减分２０分为有效果限值;利用副反应清单比较了     

脑苷激肽合并抗精神病药物治疗精神分裂症临床疗效观察

目的 观察脑苷激肽合并抗精神病药物治疗精神分裂症的临床疗效观察。方法 将80例精神分裂症患者随机分为两组,分别给予抗精神病药物合并脑苷激肽联合治疗（观察组）,和单用抗精神病药物（对照组）,治疗为8周。采用简表精神科量表（BPRS）,阴性症状量表（SANS）定期进行评定。结果 观察组总有效率为85％,对照组为70％,差异显著（x^2=3.66,P＜0.05）,两组（BPRS）,（SANS）评分在第2周、第4周、第8周、差异均有显著性（P＜0.01）。结论 用脑苷激肽合并抗精神病药物治疗精神分裂症比单纯应用抗精神病药物疗效显著。     

Relationship of Change in Plasma Clozapine/N-desmethylclozapine Ratio with Cognitive Performance in Patients with Schizophrenia

ObjectiveThe clozapine/N-desmethylclozapine (NDMC) ratio is proposed to be used as a predictor of cognitive performance in clozapine-treated patients, as its principal metabolite, NDMC, has an opposite action with clozapine on the cholinergic system. The aim of this study is to determine whether clozapine has influence on cognitive performance in accordance with changes in the clozapine/NDMC in patients with schizophrenia. MethodsThe data of fifteen patients with schizophrenia, who had initial and follow-up assessments after starting clozapine treatment, were retrospectively collected. The assessments included clinical scale, cognitive battery, and pharmacological data including plasma concentrations of clozapine and NDMC. The data were analyzed with Pearson correlation and stepwise multiple regression analyses. ResultsΔAttention/vigilance, Δsocial cognition, and Δcomposite score had a significant correlation with Δclozapine/NDMC ratio, while ΔWorking memory had correlation with Δclozapine concentration and ΔNDMC concentration, and Δsocial cognition had association with Δclozapine concentration. Multiple regression analysis showed that Δattention/vigilance had negative association with Δclozapine/NDMC ratio, Δworking memory had negative relation with Δclozapine concentration, and that Δsocial cognition had negative association with Δclozapine concentration. ConclusionThis finding implicates that lowering the clozapine/NDMC ratio could enhance cognition in patients with schizophrenia treated with clozapine.     

Systematic Review of the Neural Effect of Electroconvulsive Therapy in Patients with Schizophrenia: Hippocampus and Insula as the Key Regions of Modulation

ObjectiveElectroconvulsive therapy (ECT) has been the most potent treatment option for treatment-resistant schizophrenia (TRS). However, the underlying neural mechanisms of ECT in schizophrenia remain largely unclear. This paper examines studies that investigated structural and functional changes after ECT in patients with schizophrenia. MethodsWe carried out a systematic review with following terms: ‘ECT’, ‘schizophrenia’, and the terms of various neuroimaging modalities. ResultsAmong the 325 records available from the initial search in May 2020, 17 studies were included. Cerebral blood flow in the frontal, temporal, and striatal structures was shown to be modulated (n=3), although the results were divergent. Magnetic resonance spectroscopy (MRS) studies suggested that the ratio of N-acetyl-aspartate/creatinine was increased in the left prefrontal cortex (PFC; n=2) and left thalamus (n=1). The hippocampus and insula (n=6, respectively) were the most common regions of structural/functional modulation, which also showed symptom associations. Functional connectivity of the default mode network (DMN; n=5), PFC (n=4), and thalamostriatal system (n=2) were also commonly modulated. ConclusionDespite proven effectiveness, there has been a dearth of studies investigating the neurobiological mechanisms underlying ECT. There is preliminary evidence of structural and functional modulation of the hippocampus and insula, functional changes in the DMN, PFC, and thalamostriatal system after ECT in patients with schizophrenia. We discuss the rationale and implications of these findings and the potential mechanism of action of ECT. More studies evaluating the mechanisms of ECT are needed, which could provide a unique window into what leads to treatment response in the otherwise refractory TRS population.     

Associations of Clozapine Use With Psychosocial Functioning and Quality of Life in Patients With Schizophrenia: A Community-Based Cross-Sectional Study

ObjectiveMore attempts have been made recently to improve psychosocial functioning and quality of life in patients with schizophrenia, due to their crucial role in long-term outcomes. Previous studies on the effects of clozapine on psychosocial functioning have been limited in terms of generalizability and application to clinical practice. This study examined the relationship of clozapine use with psychosocial functioning and quality of life in patients with schizophrenia in a real-world setting. MethodsData were obtained from a survey targeting community-dwelling patients with schizophrenia. The Behavior and Symptom Identification Scale (BASIS) and Satisfaction with Life Scale (SWLS) were administered to evaluate psychosocial functioning and quality of life, and patients were classified into Clozapine and Non-clozapine groups. Group differences were assessed using ANCOVA, with additional sensitivity analyses for participants on atypical antipsychotic medications only. ResultsOf 292 patients, the Clozapine group (n=34) had significantly better psychosocial functioning and quality of life than the Nonclozapine group (n=258), as demonstrated by their low BASIS score (F=4.651, df=1, 290, p=0.032) and high SWLS score (F=14.637, df=1, 290, p<0.001). Similar findings for psychosocial outcomes were observed in the analyses of the atypical antipsychotic subgroup (n=195). ConclusionFor optimal recovery in schizophrenia, restoration of impaired social functioning and enhanced satisfaction with life are essential. In this study, clozapine use was related to high levels of psychosocial functioning and quality of life in real-world settings. Further research on the causal relationship between clozapine use and psychosocial functioning is needed.     

CBT联合小剂量利培酮治疗精神分裂症患者幻听的临床效果及安全性研究

目的探讨认知行为治疗(CBT)联合小剂量利培酮在治疗精神分裂症幻听中的临床效果和安全性。方法采用随机数字表法将80例符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)精神分裂症诊断标准的伴有幻听的患者分为CBT干预组(研究组)与药物治疗组(对照组)各40例,均采用非典型抗精神病药利培酮片治疗,CBT组药物剂量约为对照组的1/3,同时予以CBT干预。分别于入组时、3个月、6个月及随访6个月采用阳性和阴性症状量表(PANSS)、幻听量表(AHRS)、副反应量表(TESS)评定患者的临床疗效及副反应情况。结果治疗3个月、6个月及随访6个月两组的PNASS评分、AHRS评分均较治疗前降低,差异有统计学意义(P0.05或0.01);随访6个月时,两组间比较差异有统计学意义(P0.05)。对照组不良反应发生率高于研究组,差异有统计学意义(χ2=5.7826,P0.05)。结论 CBT联合小剂量抗精神病药物及足量抗精神病药物治疗精神分裂症幻听均有临床效果,前者疗效的持续性及不良反应发生率可能优于后者,但需要进一步研究。     

117例精神分裂症婚姻状况的调查报告

目的了解精神分裂症的疾病与婚姻的关系。方法调查中年以上的在院精神分裂症病人的婚姻产生维持与转归的背景资料,以及精神疾病的相关问题,不同婚姻状况下精神疾病状况精神病量表SAPS,SANS的差别。结果(1)117例精神分裂症中,69例有婚姻史(占总数58%)。其中包括离婚30例(占有婚姻史总人数43%)。(2)有婚姻史其初病年龄推迟,平均为(29.81±8.29)岁,与无婚姻史初病年龄(24.04±5.17)岁的差异有极其显著意义(P<0.001)。(3)有婚姻史组的精神病性衰退较无婚姻组略轻,SANS的差异有极其显著意义(P<0.001)。(4)有婚姻史组家庭支持明显优于无婚姻组。(5)离婚组与未离婚组之间的初发年龄和精神病状况相比差异无显著意义。(6)精神分裂症婚姻职能在病后均显示较差。结论精神分裂症有或无婚姻史与其初发年龄有关。有婚姻史病人社会家庭照顾明显改善,精神病性衰退的严重度相对略轻,而精神分裂症病人婚姻职能均差。     

氦氖激光穴位照射治疗具有幻听症状的精神分裂症对照研究

目的：探讨氦氖激光穴位照射治疗具有幻听症状的精神分裂症的疗效。方法将120例具有幻听症状的精神分裂症随机分成二组,一组用氯丙嗪,另一组用氯丙嗪联合氦氖激光,对幻听消失情况及治疗前后BPRS评分进行比较。结果氯丙嗪联合氦氖激光治疗组较氯丙嗪组,幻听消失快,显效率高。结论氦氖激光对具有幻听症状的精神分裂症是一种有效的辅助治疗。     

精神分裂症吸烟状况对免疫功能的影响

目的初步探讨吸烟对精神分裂症患者细胞因子及体液免疫的影响。方法把符合ICD-10关于精神分裂症诊断标准的精神分裂症患者分为吸烟组(均为男性)30例和非吸烟组43例,并以健康对照组比较,对患者组、健康组用酶联免疫吸附法(ELISA)测定血清IL-12、TNF-α水平;用透射比浊法测定IgA、IgM、IgG、C3、C4水平,患者组用阳性与阴性症状量表(PANSS)进行精神症状评定。结果精神分裂症患者的非吸烟组血清IL-12水平比吸烟组高,但未达到统计学上意义,其他的六个指标比较亦无显著差异。健康组非吸烟者的IL-12与IgG水平显著高于吸烟者(P<0.05)。吸烟的健康组与患者组相比,患者组C3、C4血清水平明显降低(P<0.01),IgG明显增高(P<0.01)。从性别比较,健康女性的IgG、IgM血清水平较男性高(P<0.05)。在患者组,女性较男性IgG、TNF-α的浓度明显增高(P<0.05)。结论吸烟、性别是影响精神分裂症患者免疫功能的重要因素之一,吸烟与精神分裂症共同作用于免疫系统,进一步加重其免疫功能紊乱。