内观认知疗法对精神分裂症稳定期患者服药依从性影响的研究

发布时间：2018-10-12 11:58

【摘要】：目的:精神分裂症是一种进行性恶化的慢性精神疾病,致残、致死及复发率均高于同类疾病。疾病的治疗目前还是以药物治疗为主,但因为该病患者一般都缺乏服药依从性,造成了疾病频繁复发、负担加重和生存质量严重损害等不良后果。近年来,运用心理治疗改善该症患者的服药依从性愈发得到重视,内观疗法、认知治疗等均取得一定疗效。本研究以DNCT(分散内观认知疗法)对稳定期精神分裂症患者服药依从性进行干预研究,以评价其临床疗效,为改善稳定期精神分裂症患者服药依从性的治疗探索一种可操作性强、作用持续时间长且副作用小的方法。方法:将2016年1月至4月在天津市安康医院住院,符合入组标准和排除标准的60名患者作为研究对象。选用随机数字表法,把患者分为2组,分别为研究组、对照组,每组人数各占1/2;研究组在既往药物治疗不变的情况下合并分散内观认知治疗,治疗需连续8周,每天3小时;对照组则在既往药物治疗不变的情况下接受同样时间的工娱治疗;两组在治疗前、治疗后、治疗半年后各进行一次PANSS(阳性与阴性症状量表)、ITAQ(自知力与治疗态度问卷)、自知力自评量表、服药依从性量表、MARS(药物依从性量表)的评定。结果:60例患者均顺利完成研究,进入结果统计。治疗开始前研究组和对照组各项指标比较均无统计学差异。(1)研究组经治疗后PANSS总分及各分项与治疗前比较明显降低,有显著统计学差异(P0.01);研究组在治疗半年后随访发现除复合量表以外的,其余各项评分均明显优于治疗前,有显著统计学差异(P0.01);治疗结束时及半年随访时研究组PANSS量表总分及各项评分均较对照组降低。(2)研究组治疗后自知力自评量表评分较治疗前升高,有统计学差异(P0.05);研究组半年随访时自知力自评量表评分高于治疗前,具有显著统计学差异(P0.01);治疗后、半年随访时,研究组自知力自评量表评分均较对照组高,有统计学差异(P0.05)。(3)研究组治疗后及半年随访时ITAQ高于治疗前,具有显著统计学差异(P0.01);治疗后、半年随访时,研究组ITAQ均比对照组高,有统计学差异(P0.05)。(4)研究组治疗后及半年随访时MARS各因子分值均较治疗前升高,有显著统计学差异(P0.01);治疗后、半年随访时研究组各因子分值均较对照组高,有统计学差异(P0.01或P0.05);(5)治疗后研究组服药依从性量表中“治疗依从”的例数明显增加,所占比例增加了46%,对照组增加了7%,有显著统计学差异(P0.01)。结论:(1)在药物治疗的基础上,使用内观认知疗法,可以改善精神分裂症稳定期患者的各种精神症状,阴性症状及占优势的综合征改善尤为明显;(2)在药物治疗的基础上,使用内观认知疗法,可以明显改善精神分裂症稳定期患者的自知力;(3)在药物治疗的基础上,使用内观认知疗法,可以提高精神分裂症稳定期患者服药依从性,明显改善对精神药物副反应的消极态度;(4)通过治疗后半年,进行随访发现:分散内观认知疗法的疗效在一定时间范围内能够保持较好效果。
[Abstract]:Objective: Schizophrenia is a kind of progressive deterioration of chronic mental illness, disability, death and recurrence rate are higher than that of the same kind of disease. The treatment of disease is still mainly drug therapy, but because the patient is generally lack of medication compliance, it causes frequent recurrence of disease, severe burden and serious damage to the quality of life. In recent years, the use of psychotherapy to improve the compliance of patients with this disease has gained more attention, internal view therapy, cognitive therapy and so on. In this study, the compliance of patients with stable schizophrenia treated with DNCT (internal cognitive therapy) was studied in order to evaluate its clinical efficacy, and to explore an effective way to improve the compliance of patients with schizophrenia in stable period. a method of long duration and small side effects. Methods: Sixty patients who were hospitalized in Ankang Hospital of Tianjin from January to April 2016 were enrolled as research subjects. The patients were randomly divided into two groups: study group and control group, each group was 1/ 2; The control group was treated with the same time as the previous drug therapy; two groups were treated before and after treatment, each time after six months of treatment, the PANSS (positive and negative symptom scale), ITAQ (positive and treatment attitude questionnaire) and self-rating scale self-rating scale were performed. Evaluation of drug compliance scale, MARS (drug compliance scale). Results: All 60 patients successfully completed the study and entered the results statistics. There was no statistical difference in the indices of the study group and the control group before treatment. (1) After treatment, the total score of PANSS and the scores of each sub-item were significantly lower than that before treatment (P <0.01). The total scores and scores of PANSS were lower in the study group at the end of treatment and half-year follow-up. (2) The self-rating scale score was higher in the study group than before the treatment (P0.05). The scores of self-rating scale were higher in the study group than in the control group (P <0.05). (3) Compared with the control group, the ITAQ of the study group was higher than that of the control group (P0.05). (4) After treatment and half-year follow-up, the scores of all factors of MARS increased significantly before treatment (P <0.01), and the scores of each factor in the study group were higher than those in the control group at half-year follow-up, and there was statistical difference (P 0.01 or P 0.05). (5) Drug compliance scale of study group after treatment "Treatment compliance" The number of cases increased significantly, the proportion increased by 46%, the control group increased by 7%, there was significant statistical difference (P0.01). Conclusion: (1) On the basis of drug therapy, we can improve the mental symptoms, negative symptoms and the improvement of syndrome in stable patients with schizophrenia by using internal cognitive therapy. (2) On the basis of drug therapy, we use internal cognitive therapy. (3) using internal view cognitive therapy on the basis of drug therapy to improve the compliance of drug administration in patients with schizophrenia and improve the negative attitude to side reaction of psychotropic substances; (4) After six months of treatment, the follow-up findings show that the therapeutic effect of the cognitive therapy in dispersion can keep better effect over a certain period of time.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.3

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