首发精神分裂症女性患者康复期存在的心理问题

Mental problems still existing in female patients with first-onset schizophrenia at convalescence

目的:调查首发精神分裂症女性患者进入康复期后的心理状况,并将其抑郁,焦虑评分与国内常模数据相比较。方法:对2004-03/07河南省精神病医院早期干预一科收治的50例女性首发精神分裂症患者,采用量表测评其心理状态。由精神科护师用统一的指导用语讲解量表的目的、意义及填写方法,在干预一科由患者自己填写,量表当场收回。由2名经过培训的主治医师对量表进行盲法评定,并与国内常模比较,同时针对患者的心理状态进行护理干预。应用抑郁自评量表(由20个条目组成,采用4级评分,1分为从无或偶而,2分为有时,3分为经常,4分为总是如此。各条目累计分越高,抑郁程度越重)评估患者的抑郁状态。应用焦虑自评量表(含20个项目,采用4级评分,根据主要评定项目所定义的症状出现的频度,其标准为1没有,2小部分时间,3相当多时间,4绝大部分时间或全部时间。分数越高,焦虑的症状越严重。总分<50分者为正常;50～60分者为轻度焦虑,61～70分者是中度焦虑,70分以上者是重度焦虑)评估患者的焦虑状态。结果:发放量表50份,收回合格量表50份,回收率100%。①50名患者康复期的心理状况:患者多有自卑感、内疚、挫折感,担心药物副作用,担心身体发胖影响外观,对月经失调甚至闭经忧心忡忡,关注住院费用,常有情绪不稳定和心烦的感觉等。②焦虑及抑郁的发生率及其症状表现:焦虑抑郁发生率分别为48%(24/50)、64%(32/50)高于普通国内常模的发生率25%和15.1%～22.5%。患者出现频率较高的焦虑抑郁症状为:抑郁心境、焦虑;自我贬值、空虚感;思维混乱;睡眠障碍;易激惹。③患者的焦虑自评量表和抑郁自评量表评分与国内常模的比较:患者焦虑自评量表评分显著高于国内常模(58.96±11.05,42.98±9.94,P﹤0.01);其抑郁自评量表评分亦明显高于国内常模(62.17±14.76,41.88±10.51,P﹤0.01)。结论:首发精神分裂症女性患者在康复期仍存在较明显的心理问题,表现为情绪化、焦虑;能力减退;思考困难;睡眠不好;易生气、激动。因此,此期仍需得到关注,关爱及其社会和家庭的支持,以及必要的药物治疗。

AIM：To investigate the mental status of female patients with first-onset schizophrenia at convalescence, and compare their scores of depression and anxiety with the data of national norms.METHODS：Fifty cases of female patients with first-onset schizophrenia,who were treated in the First Department of Early Intervention, Second Affiliated Hospital of Xinxiang Medical College between March and July 2003, were surveyed with scales to evaluate their mental status. The purpose, significant and filling method of the scales were explained by psychiatric nurse with the unified instruction, and the scales were completed by the patients themselves in the first department of intervention and then collected on the spot. The scales were assessed by two trained attending physicians with blinded method, and compared with the data of national norms, Nursing interventions were given according to the mental status of the patients. The depressive status of the patients was evaluated with the self-rating depression scale was composed by 20 items, scored by 4 degrees： 1 point as none or occasionally, 2 points as sometimes, 3 points as usually, 4 points as always like this; The higher the summation of each score, the severer the depressive degree. The self-rating anxiety scale,which was consisted of 20 items, scored hy 4 degrees： 1 point as none or occasionally, 2 points as sometimes, 3 points as usually, 4 points as always like this; The higher the summation of each score, the severer the depressive degree. The anxiety status of the patients was assessed with the self-rating anxiety scale was composed by 20 items; scored by 4 degrees：according to the appearing frequency of the symptoms defined by the main evaluation item, the standards were that 1 point as none, 2 points as a small part of time, 3 points as quite a lot of time, 4 points as most of or all the time; The higher the scores, the severer the symptom; The total score of lower than 50 was taken as normal, 50 to 60 as mild, 61 to 70 as moderate, above 70 as severe.RESULTS： Totally 50 scales were sent out, and 50 qualified ones were collected, and the collection rate was 100%. ① Mental status of the 50 patients at convalescence： Most of the patients had feeling of inferiority,remorse, feeling of frustration, worries about the side effects of the drug and becoming fat which can affect their appearance, anxiety about disturbance of menstruation or even menoschesis, attention to the cost of hospitalization, they often had the emotional instability and feeling of upset. ② The occurrence rates and the symptom manifestations of anxiety and depression： The occurrence rates of anxiety and depression in the patients [48%（24/50）, 64%（32/50）] were higher than those of national norms（25%, 15.1% to 22.5%）. The symptoms of depression and anxiety occurred more frequently in the patients were depressive mood and anxiety; selfdepreciation and feeling of empty; confusion of thinking; sleep disorder;irritability. ③ Comparison of the scores of self-rating depression and anxiety scales between the patients and national norms： The scores of self-rating depression scale and self-rating anxiety scale were all significantly higher in the patients than the national norms [（58.96±11.05, 42.98±9.94,P〈 0.01）： （62.17±14.76. 41.88±10.51. P〈 0.01）].CONCLUSION：Female patients with first-onset schizophrenia at convalescence still have obvious mental problems, the manifestations are emotionalization, anxiety, decline of ability, thinking difficulty, bad sleep,easy to get angry and excited, so the patients at this period still need more attention and care, more supports from both the society and family, and necessary drug treatment.