帕利哌酮联合心理干预治疗首发精神分裂症的临床疗效及社会功能研究

目的 评价帕利哌酮缓释片联合心理干预对首发精神分裂症门诊治疗患者的临床疗效及社会功能恢复的疗效.方法 对符合DSM-Ⅳ诊断标准的62例首发精神分裂症患者进行为期12个月的研究.患者随机分为两组,对照组接受帕利哌酮常规治疗;试验组在常规治疗的基础上给予每月1次心理干预.采用阳性与阴性症状量表(PANSS)个人和社会功能量表(PSP)分别在基线和治疗后第1,3,6,9,12月末评定其疗效及社会功能;于治疗9个月后评定临床痊愈等情况.安全性采用Barnes静坐不能量表(BARS)、锥体外系副反应量表(SAS)及不自主运动量表(AIMS)等评定.结果 心理干预联合药物治疗组共27例,单用药物治疗对照组共17例完成试验,脱落率分别为12.9%、45.2%,组间差异具有显著性(P＜0.05).两治疗组治疗后PANSS及PSP总分相对治疗前均有显著改善(P＜0.05),其中心理干预组PANSS减分率＞30%、PSP评分提高≥7、达到临床痊愈标准的患者比例为74.2%、51.6%、67.7%,优于单用药物治疗组的45.2%、38.7%、38.7%(P＜0.05).两治疗组不良事件发生率及类型相似,主要不良反应为锥体外系、心动过速、肠胃道反应、等静坐不能等.结论 帕利哌酮缓释片联合心理干预能提高首发精神分裂症门诊患者的治疗依从性.降低治疗中断率,提高临床痊愈患者比例并促进患者社会功能的康复.

The effect of combination treatment by paliperidone and psychological intervention on first-episode schizophrenic out-patient

Objective To evaluate the effect of combination treatment by psychological intervention and a new atypical antipsychotic Paliperidone extended-release tablets(paliperidone ER)on first-episode schizophrenic out-patients.Methods All 62 patients diagnosed as first-episode schizophrenia by DSM-Ⅳ were randomly allocated into,combination treatment group and control group,for a 12-month treatment study.The combination treatment group was treated by paliperidone ER once a day and psychological counseling once a month,while the control group was treated only by paliperidone ER.The efficacy and social function were assessed by Positive and Negative Syndrome Scale(PANSS)and Personal and Social Performance Scale(PSP)individually at baseline,and following 1,3,6,9,12 months.The remission rate was calculated at the end of the 3rd,6th,9th month.The safety and tolerability were assessed using Barnes Akathisia Scale(BARS),extrapyramidal side effects scale(SAS)and involuntary movement scale(AIMS).Results Twenty-seven patients of combination treatment group and seventeen patients of the control group completed the trial with the discontinuation rate 12.9% and 45.2%,respectively.The difference between the above two groups was statistically significant(P＜0.05).The mean total score of PANSS and the PSP of the both groups were significantly improved(P＜0.05)after treatment.PANSS total score reduced more than 30% compared with baseline,and PSP total score increased more than 7.The remission rate of combination treatment group was 74.2%,51.6% and 67.7% at the end of 3rd,6th,and 9th month,which was better than the control group(45.2%,38.7% and 38.7%)(P＜0.05).Both incidence and types of adverse events were almost same between the two groups.The major adverse events were extrapyramidal symptoms,tachycardia,gastrointestinal discomfort and akathisia.Conclusion Paliperidone ER treatment combined with psychological intervention on first-episode schizophrenia out-patients can improve their treatment compliance by reducing the discontinuation rate.And this combination treatment can increase the remission rate and improve social functioning of the patients.