结构式家庭疗法治疗难治性强迫症患者7例

Structural family therapy in 7 patients with refractory obses-sive-compulsive disorder

目的:探讨结构式家庭治疗对难治性强迫症患者的干预效果。方法:选择2004-04/2005-02北京回龙观医院心理治疗病房及张山营精神卫生保健院就诊的难治性强迫症患者7例,患者家属或监护人均知情同意。在初次访谈后,邀请患者及家庭成员参加治疗性会谈,每次由家庭治疗师及协同治疗师共同进行1h左右的治疗,每个家庭平均进行4次,治疗间隔2～7d不等,每次治疗均进行录像。治疗期间未服用任何药物及进行其他治疗。治疗前后用家庭环境量表中文版(分为10个分量表,分别评价不同的家庭特征:①亲密度。②情感表达。③矛盾性。④独立性。⑤成功性。⑥知识性。⑦娱乐性。⑧道德宗教观。⑨组织性。⑩控制性)对患者及家庭每位成员进行评价,并用耶鲁布朗强迫症状量表对患者进行评价(总分为40分,0～40分为亚临床～极重度)。治疗后依据录像记录患者家庭在每次治疗中的现场表现,并对患者及家庭对治疗的满意度进行调查,同时调查周围病友对患者进行家庭治疗后所观察到的变化。结果:7例患者全部进入结果分析。①患者及家属的治疗满意度为85.71%。②患者耶鲁布朗强迫症状量表评分:治疗后评分显著低于治疗前10.75±3.06,24.21±3.33(t=3.44,P<0.01)。③患者及家属家庭环境量表评分:治疗后的家庭环境量表亲密度、情感表达因子分显著高于治疗前(7.24±2.05,6.13±2.11);(5.45±1.78,4.62±1.96)(t=3.23,3.67,P<0.01),治疗后的矛盾性、控制性因子分显著低于治疗前(2.44±1.66,3.58±1.87);(4.38±2.23,4.65±2.19)(t=2.98,2.25,P<0.05)。结论:结构式家庭治疗有助于减轻难治性强迫症患者的强迫症状,增进家庭的亲密感及情感交流,减少家庭矛盾,为患者提供更良好的家庭支持系统,进一步促进其社会功能的康复。

AIM： To access the effectiveness of structural family therapy on patients with refractory ohsessive- compulsive disorder （OCD）.METHODS： Seven patients with refractory OCD, who were treated in Beijing Huilongguan Hospital and Zhangshanying Mental Health Hospital between April 2004 and February 2005, were involved in the study with the permission of their relatives or guardians. After the first interview, the refractory OCD patients and their family memhers were invited to the family therapy session. There were 4 sessions for each family averagely.The family therapist and co-therapist interviewed the family for about one hour each time. The interval of the sessions was ahout 2-7 days, all the sessions were recorded. There was no drug and other treatment for the patients dur-ing therapy. The Chinese version of family environment scale was used to access the patients and their family members before and after the treat-ment. The patients were accessed with the Yale-Brown obsessive-compul-sive symptom scale and the videotapes. The patients and their family members were accessed the degree of satisfactions about therapy.RESULTS： All the 7 cases were involved in the analysis of results. ① The satisfactory degree of the patients and their family members was 85.71%. ②The Yale-Brown score of the patients after therapy was significantly lower than that before therapy （10.75±3.06, 24.21±3.33, t=3.44, P 〈 0.01）. ③ The scores of intimacy and affection expression after therapy were significantly higher than those hefore therapy [（7.24±2.05,6.13±2.11）; （5.45±1.78,4.62±1.96）, t=3.23, 3.67, P 〈 0.01], the scores of contradiction and controlling were significantly lower than those before therapy [（2.44±1.66,3.58±1.87）; （4.38±2.23, 4.65±2.19）, t=2.98, 2.25, P 〈 0.05].CONCLUSION： Structural family therapy is useful for releasing the symptom of refractory OCD patients, promoting the intimacy and affection communication and decreasing the contradiction of family. It is efficient to refractory OCD patients and worth to spread.