康复期精神病和双相情感障碍患者自知力的差异及其影响因素

Differences of insight and its influencing factors between patients with schizophrenia and bipolar disorder during rehabilitation period

目的:了解康复期精神分裂症和双相情感障碍患者自知力的差异及其影响因素。方法:对40例精神分裂症患者、30例精神病性双相障碍患者及32例非精神病性双相障碍患者的自知力及其影响因素进行评估,并作Logistic回归分析。结果:精神分裂症患者的自知力与精神病性双相障碍患者的自知力差异无显著性(χ2=0.038,P=0.812),但两者的自知力均低于非精神病性双相障碍患者,差异有显著性意义(P<0.05)。在康复期,虽然患者的精神症状基本缓解,但仍有36%的精神分裂症、38%的精神病性双相障碍以及10%的非精神病性双相障碍患者存在自知力损害。精神分裂症组患者的自知力损害是非精神病性双相障碍组患者的4.65倍(95%CI=1.02～20.80),而精神病性双相障碍患者的自知力损害为非精神病性双相障碍组的5.72倍(95%CI=1.30～24.76)。并且,患者的性别、年龄、病程和住院次数均与自知力均分无关。结论:康复期大多数精神病患者的自知力恢复良好,但仍有少数患者存在自知力损害,影响患者自知力恢复的主要因素为精神病性症状。

AIM:To explore the differences of insight and its affecting factors in patients with schizophrenia and bipolar disorder during the period of rehabilitation. METHODS:The insight and its affecting factors were assessed in 40 patients with schizophrenia,30 patients with psychotic bipolar disorder(PBD) and 32 patients with non psychotic bipolar disorder(NPBD),and then the Logistic regression analysis was conducted. RESULTS:There was no significant difference in insight between patients with schizophrenia and PBD(χ2=0.038,P=0.812),but both were significantly lower than that of patients with NPBD(P< 0.05).During the rehabilitation period,although the psychiatric symptoms of the patients were improved generally,insight impairment still existed in 36%with schizophrenia,38%with PBD and 10%with NPBD,the insight impairment of the patients with schizophrenia was 4.65 times severer than that of patients with PBD(95%CI=1.02-20.80),which was 5.72 times severer than that of patients with NPBD(95%CI=1.30-24.76).Besides,the insight impirment was not related to the sex,age,disease course andnumber of hospitalization. CONCLUSION:Most patients with schizophrenia have good recovery of insight,but insight impairment still exists in several patients.The main affecting factor of insight recovery is the psychotic symptom.