家庭干预对精神分裂症患者康复作用的系统性评价

目的：探讨家庭干预对精神分裂症患者康复作用的临床研究质量及疗效。方法：计算机检索中国生物医学文献数据库（CBMdisk）和中文科技期刊数据库（VIP，1989—2005），收集有关家庭干预对精神分裂症患者康复作用与常规药物治疗相比较的随机对照试验文献．由两名评价者独立评价纳入研究的文献质量，并进行了Meta分析。结果：符合纳入标准的随机对照实验（randomized control trial，RCT）共9个，但其方法学质量均欠佳（C级）。与对照组相比，家庭干预对精神分裂症患者的服药依从性有明显的增效作用[RR1．69，95％CI（1．21，2．37），P=0．0021，敏感性分析后得到的结果略有下降[RR1．46，95％CI（1．22，1．75），P〈0．0001]。结论：目前有关家庭干预对精神分裂症患者康复作用的临床研究在科研方法学的应用方面仍有差距。本研究提示，家庭干预可能对精神分裂症患者的服药依从性有一定的增效作用，但不排除与实验方法学质量低下及发表性偏倚有关。     

结构式家庭心理治疗对已婚精神病患者家庭及婚姻状况的影响

目的：尝试结构式家庭心理治疗在已婚精神病患者临床治疗过程中的应用。方法：精神异常症状缓解的已婚精神分裂症患者60例,随机分为家庭组和对照组各30例,均坚持服用非典型抗精神病药物治疗。家庭组患者则在此基础上由心理治疗师和临床医生进行每2周1次,每次60min的结构式家庭治疗。治疗前后对2组患者均采用家庭功能量表（FAD）、Locke-Wollance婚姻调适量表评定。结果：通过家庭治疗2个月后,与治疗前及对照组比较,家庭组患者FAD和Locke-Wollance婚姻调适量表评分均明显提高（P〈0.05或0.01）。结论：精神病患者辅以家庭治疗可不同程度的改善已婚精神病患者的家庭状况及婚姻质量,且优于单用抗精神病药物治疗的患者。     

The validity and reliability of the measurement of the concept 'expressed emotion' in the family members and nurses of Hong Kong patients with schizophrenia

This study aimed to test the validity and reliability of three measures of expressed emotion in a sample of family members and nurses of Hong Kong Chinese people with schizophrenia. Little research has been done in Hong Kong in relation to family expressed emotion (EE) and schizophrenia so the present study set out to pilot some measures that could become reliable and valid measures for future clinical studies. The Adjective Check List (ACL) and the Family Attitude Scale (FAS) were compared to EE ratings obtained after a brief interview. The ratings were made based on the conceptual framework of the Camberwell Family Interview, which includes the dimensions of criticism, hostility and emotional over-involvement. Twenty-one family members and their primary nurses participated in the study which revealed that 13 of the family members and 10 of the primary nurses were rated as high EE, either in terms of criticism, emotional over-involvement or both, based on the interview. The differences in the mean FAS scores between the high EE groups and the low EE group was large but not statistically significant, and there was a significant correlation between the FAS and the brief interview. The ACL revealed some interesting results in terms of the way relatives and nurses see themselves responding to the person with schizophrenia and vice versa. Recommendations for future studies and family education strategies are made .     

心理干预改善首发精神分裂症患者家属负性情绪的效果观察

目的了解心理干预对首发精神分裂症住院患者家属负性情绪的影响。方法采用焦虑自评量表(SAS)和抑郁自主量表(SDS)对符合调查对象条件的74位首发精神分裂症住院患者家属进行测试,并对家属存在的焦虑、抑郁情绪采取有效的心理干预,比较家属在接受心理干预前后焦虑、抑郁情绪的变化。结果心理干预可有效改善首发精神分裂症住院患者家属的情绪状况,组间比较,差异具有统计学意义(P<0.05)。结论首发精神分裂症患者家属负性情绪明显,心理干预可有效改善其情绪状况,使其能正确面对现实并积极应对,尽早恢复自信,为患者的疾病康复提供有效的家庭支持。     

Genes and schizophrenia: a pseudoscientific disenfranchisement of the individual

The biological model of schizophrenia remains the dominant model within mental health services. It has a powerful influence on the culture of mental health services; providing the structure for the delivery and selection of mental health treatments. There is widespread acceptance of a genetic cause for schizophrenia. Acceptance of a genetic cause is inconsistent with a person-centred recovery-orientated approach. The following paper provides a rigorous review of the underpinning research that supports the genetic argument. Appraisal of family, twin and adoption studies uncovers serious flaws in the methodologies and statistical analyses used in studies. These flaws not only artificially inflate the genetic contribution to schizophrenia but also invalidate many of the findings. More recent micro-imaging techniques have also failed to find replicable and consistent findings indicating a clear genetic pathway to schizophrenia. Freed from the implied pessimism of an unmodifiable genetic cause for schizophrenia, mental health nurses can confidently work to instil hope with people that have a diagnosis of schizophrenia.     

精神分裂症患者服药依从性与家庭环境的相关性研究

目的：分析精神分裂症患者服药依从性与家庭环境的相关性。方法：对495名精神分裂症患者进行问卷调查。调查工具包括一般资料问卷、家庭环境量表中文版（FES-CV）和精神分裂症患者服药依从性问卷。结果：单因素分析结果显示,年龄、病程、住院次数、就诊方便程度、家庭经济状况、医疗费用情况和家人是否参加过健康教育是精神分裂症患者服药依从性的影响因素（P〈0.05）;精神分裂症患者家庭环境量表各维度得分与国内常模相比均有统计学差异（P〈0.05）;精神分裂症患者服药依从性量表各维度得分与家庭环境量表各维度得分相关（P〈0.05）;分层回归分析显示,亲密度、病程、就诊方便程度和住院次数均为精神分裂症患者服药依从性的影响因素。结论：精神分裂症患者服药依从性与其家庭环境密切相关,应加强对患者家庭的护理干预,以提高患者的服药依从性。     

家庭护理干预对首发儿童精神分裂症病人疗效的影响

[目的]探讨家庭护理干预对首发儿童精神分裂症病人疗效的影响.[方法]选择在我院门诊就诊的60例首发儿童精神分裂症病人,随机分为常规组和研究组各30例.常规组给予一般的门诊服务,进行常规的用药指导及预约门诊.研究组除给予一般.的门诊服务方式外,进行家庭护理干预,采取面谈、电话等形式与病人及家属进行心理沟通.8周后按我国现行4级疗效评定标准进行疗效评估.[结果]两组患儿治疗8周时,显效率比较有统计学意义(P＜0.05).[结论]家庭护理干预能明显提高首发儿童精神分裂症病人的治疗效果,是药物治疗手段以外的重要辅助治疗措施,对病儿及家属尤为重要.     

Effectiveness of family interventions for patients with schizophrenia: A systematic review and meta-analysis

The family is the primary caregiver for most patients with schizophrenia, and their roles are essential in patients' illness trajectories and outcomes. Due to this, various family interventions for schizophrenia have been developed and applied to the relatives who take care of their family members with schizophrenia. This study examined the effectiveness of existing family interventions for schizophrenia in achieving their target outcomes at both the family and patient levels by utilizing a systematic review and meta-analysis. Combinations of terms were used to search for relevant studies from the databases. Thirty-seven randomized controlled trials that met the inclusion criteria were included in the analysis. Based on the pooled result of the included studies, the programmes significantly improved the targeted outcomes with large effect size. The programmes' impacts on family-related outcomes were higher than those on patients. Among the targeted outcomes, patients' treatment satisfaction and adherence and family caregivers' mental health were the most remarkable outcomes that had improved from the included programmes. Conversely, outcomes related to family relationships, caregiving experiences, perceived social support of family caregivers, and patients' medication use did not see significant improvements. The programmes delivered to individual family units and only to the family caregivers were more effective than those delivered to groups of caregivers and caregivers and patients together, respectively. Programme-focused interventions were more effective than emotion-focused ones. Based on these findings, an in-home visiting nurse programme or advanced technology is suggested when applying family interventions for schizophrenia in practice.     

以家庭为中心的干预对精神分裂症照料者情感表达及监护水平的影响

目的探讨以家庭为中心的干预对精神分裂症照料者情感表达及监护水平的影响。方法将临床"痊愈"出院的263例精神分裂症患者分为研究组(132例)和对照组(131例),两组患者出院后均给予抗精神药物维持治疗和一般的心理教育,研究组在此基础上实施以家庭为中心的护理干预。在干预前和干预后1年,采用自制调查表评定两组照料者的监护方式和精神分裂症知识水平,采用坎伯威家庭问卷中文版评定照料者的情感表达,并比较两组患者的复发率。结果干预1年后,照料者认为患者对急性期、缓解期治疗的态度和监护方式以及对患者的日常生活和患者对外关系的监护方式方面,两组差异具有统计学意义(P0.01);研究组照料者的批评、敌对、情感过分参入评分及高情感表达的发生率均明显低于对照组(P0.01),热情性及赞扬性评分则明显高于对照组(P0.01);研究组患者复发率显著低于对照组(P0.05)。结论以家庭为中心的干预有助于改善精神分裂症患者的治疗态度,提高照料者家庭监护水平,降低患者疾病复发率。     

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。     

Schizophrenia: problems of separation in families

BACKGROUND: In the past, family relationships of people with schizophrenia have mainly been investigated from a clinical viewpoint. The perspective of family development has generally been overlooked in this area of research. AIM: This paper reports a study exploring problems of development and detachment in families with an adult child with schizophrenia. METHOD: Using in-depth interviews, 51 parents of people with schizophrenia were questioned about their living situations and relationships with patients. FINDINGS: Spatial separation from the family home was often complicated or even prevented entirely, with patients permanently living in their parents' household or in the same neighbourhood. Many patients remained dependent on their parents' emotional, practical and financial support. Typically, the parent-child relationship was re-intensified, often with a concurrent loss of social contacts outside the family. From a biographical point of view, schizophrenia often caused problems for families by making parenthood permanent and lifelong parental support necessary. Many parents had to revise their expectations of both their ill child's development and their own personal plans. CONCLUSION: From the viewpoint of family psychology, schizophrenia is a serious obstacle to development that affects both patients and their parents. Family-related support should increasingly take into account the issue of the difficult detachment of patients from their parents.     

家庭化管理模式对慢性精神分裂症患者的疗效观察

目的：探讨重复经顿磁刺激（rTMS）对脑卒中后抑郁的疗效。方法：脑卒中抑郁患者60例,随机分为观察组和对照组各30例,2组均给子脑卒中后常规药物治疗,观察组同时给予左前额叶背外侧区（DLPFC）高频（10Hz）rTMS治疗。治疗前后分别采用美国国立卫生院神经功能缺损评分量表（N1HSS）和汉密尔顿抑郁量表（HAMI）-17）进行评定。结果：治疗4周后,2组患者NIHSS及HAMD评分均较治疗前明礁降低（P〈0．05,0．01）,且观察组更低于财照组P〈0．01）。结论：rTMS对脑卒中后抑郁有较好的疗效。     

不同的家庭及社会支持对精神分裂症患者康复的影响(附10例对比分析)

作者为探讨不同的家庭及社会支持对精神分裂症患者康复的影响,对住院确诊回归社会的10名患者直接参与了为期3年的家庭、社会支持随访,并与同期出院10例患者进行对照,结果,前者无1例再入院,其远期病情较稳定,社会功能损害轻微,说明家庭,社会支持在精神病康复中的必要性和重要性。     

依从性干预对精神分裂症患者及其家庭照顾者的影响

目的探讨依从性干预对精神分裂症患者及其家庭照顾者的影响。方法将2017年1~12月上海市浦东新区精神卫生中心护理部实施依从性干预后收治的精神分裂症患者60例及其照料者纳入观察组,将2016年1~12月该院实施依从性干预前收治的精神分裂症患者60例及其照料者纳入对照组。对照组患者接受常规健康宣教,观察组患者接受依从性干预。比较两组患者入院时、出院时及出院后3个月治疗依从性评分、自知力与治疗态度问卷(ITAQ)评分、阳性与阴性症状量表(PANSS)、世界卫生组织残疾评定项目(WHO DASⅡ)评分、生活质量综合评定问卷(GQOLI-74)评分以及家庭照顾者负担量表(ZBI)评分。结果观察组患者出院时ITAQ评分显著高于对照组,出院后3个月治疗依从性评分和ITAQ评分均显著高于对照组;观察组患者出院后3个月PANSS评分显著低于对照组,差异均有统计学意义(均P<0.05);两组患者不同时间WHO DASⅡ评分比较,差异均无统计学意义(均P>0.05);观察组患者出院后3个月GQOLI-74评分显著高于对照组,差异有统计学意义(P<0.05);观察组家庭照顾者出院后3个月ZBI评分显著低于对照组,差异有统计学意义(P<0.05)。结论依从性干预能够有效提升精神分裂症患者的治疗依从性,改善其自知力与治疗态度,提升预后效果,减轻家庭照顾者的负担。     

社区慢性精神分裂症家庭亲密度和适应性与患者精神症状的关系

目的探讨社区慢性精神分裂症家庭亲密度与适应性 ,及其与患者精神症状的相关性。方法应用家庭亲密度和适应性量表中文版 (FACESII CV)、阳性症状和阴性症状量表 (PANSS)对 5 1个社区精神分裂症家庭亲密度与适应性和患者的精神症状进行评定 ,与量表的正常参考值比较 ,进行多元相关分析。结果社区慢性精神分裂症患者家庭的适应性明显降低 (u <0 0 5或u <0 0 1) ;FACEII CV“拱极模式”中 ,平衡型比例明显减少 ,极端型比例增加 ,中间型比例无变化 ;实际亲密度得分与PANSS总分、阳性量表得分、一般精神病理量表得分呈负相关 (P <0 0 5 ) ;实际适应性得分与阳性量表得分呈负相关 (P <0 0 5 )。结论社区慢性精神分裂症家庭亲密度和适应性与患者精神症状密切相关 ,患者家庭的适应性降低。     

精神分裂症患者家庭照料者负担的影响因素及护理对策

目的研究精神分裂症患者家庭照料者负担的影响因素及干预措施,从而减轻精神分裂症患者家庭照料者的负担。方法采用人口统计学问卷（自制）和照料者负担量表（caregiver burdenscale）对96例精神分裂症患者家庭照料者进行调查。结果精神分裂症患者家庭照料者负担的影响因素包括：照料者的年龄、文化水平、婚姻状况、居住地、与患者的关系以及患者的工作状况。结论精神分裂症患者家庭照料者在照料活动中承受了相当大的负担,应针对精神分裂症家庭照料者的年龄、文化水平、婚姻状况、居住地、与患者的关系以及患者的工作状况等进行个体化护理干预,从而减轻家庭照料者的负担。     

家庭健康教育对精神分裂症患者生活质量的影响

目的探讨家庭健康教育对精神分裂症患者生活质量的影响。方法选择在我院住院治疗的92例精神分裂症患者，分为实验组和对照组，各46例。对照组进行常规的治疗与护理，实验组在此基础上同步实施家庭健康教育，并采用生活质量量表对患者进行评定。结果家庭健康教育1年后，实验组患者的生活质量评定总分及生活、心理、独立性、社会关系领域得分均优于对照组（P〈0．01）。结论家庭健康教育能明显改善精神分裂症患者的生活质量，有助于患者全面康复。