认知行为治疗对精神分裂症患者临床疗效与自知力的影响

目的探讨认知行为治疗(CBT)对精神分裂症患者疗效及自知力的影响。方法本研究为随机对照临床试验。对符合《国际疾病分类》第10版(ICD-10)精神分裂症诊断标准的患者160例,采用随机数字表法随机分为治疗组(在药物治疗基础上合并认知行为治疗,完成74例)和对照组(单纯使用抗精神病药物治疗,完成72例),CBT组在药物治疗基础上接受18次CBT。用PANSS量表、自知力与治疗态度问卷量表(ITAQ)分别于入组时、治疗第8、12、24周末各评定1次。结果①第8、12周末,两组PANSS评分与治疗前比较差异均有统计学意义(P<0.05),但组间差异无统计学意义(P>0.05);第24周末,治疗组PANSS总分、阴性症状及一般精神病理分减分比对照组明显,差异有统计学意义(P<0.01);②在12、24周末时,ITAQ得分与治疗前相比差异有统计学意义,24周末时治疗组ITAQ显著高于对照组(t=-1.792;P<0.05)。③PANSS变化值受ITAQ总分变化值的影响(B=0.423,P=0.001;B=0.156,P=0.004)。结论认知行为治疗能改善精神分裂症患者的临床症状,且明显有助于患者自知力的恢复,自知力的恢复可促进总体疗效。

The Effects of Cognitive Behavior Therapy on the Efficacy,Insight and Their Relationship of Schizophrenics

Objective To explore the effects of cognitive behavioral therapy(CBT)on the efficacy and insight of Hospitalized Schizophrenics. Methods The study is classfied as the Randomized Controlled Trial(RCT)by nature. 160 Schizophrenics,in the light of International Classification of Diseases(ICD-10)and according to the sequence in which they are hospitalized,were randomized into the treatment group(receiving drug treatment as well as cognitive behavioral therapeutics,74 cases finished)and the control group(receiving drug treatment purely,72 cases finished). CBT group received CBT of 18 times along with the drug treatment. The two groups were assessed at the time of grouping and at the end of the 8 th,12 th and 24 th week respectively by virtue of PANSS(Positive and Negative Syndrome Scale)and ITAQ(Insight and Treatment Attitude Questionnaire). Results ① At the end of 8 th and 12 th week,the PANSS scores of each group showed obvious differences after treatment as opposed to prior treatment and the differences were statistically significant(P<0.05). Whereas no statistical significances showed in scores between two groups(P>0.05). At the end of 24 th week,in contrast with the control group,the total scores of PANSS,negative syndromes and Psychopathology showed sharp decrease in the treatment group and the differences have statistical significance(P<0.01). ② At he end of 12 th and 24 th week,ITAQ has remarkable differences between two groups compared with prior treatment. At the end of 24 th week,the total scores of ITAQ of the treatment group are obviously higher than those of the control group(t=-1.792;P<0.05). ③The fluctuation of PANSS in total scores is subject to the variation of ITAQ(B=0.423,P=0.001;B=0.156,P=0.004). Conclusion CBT can contribute to the improvement of clinical symptoms and is of significance to the recovery of insight and in turn,the recovery of insgiht is beneficial to the overall therepeutic efficacy.