健康教育与行为矫正对精神分裂症患者不良行为的干预效果

Interventional effect of health education and behavior modification on the vicious behavior of patients with schizophrenia

目的:在药物治疗的基础上施以健康教育和行为矫正训练,探讨其对精神分裂症患者不良行为的作用。方法:于2003-07/2004-12分别在广州市精神病医院住院部的4个精神科病区随机选择符合中国精神障碍分类诊断标准精神分裂症诊断标准的住院精神分裂症患者240例,分为观察组和对照组各120例,男女各半。所有患者均接受抗精神病药物维持治疗和常规护理,观察组在此基础上增加健康教育(①每周由护士向患者宣传精神卫生常识。②强化行为矫正训练的效果,应用正性鼓励法,每周评分小结1次。)和行为矫正训练(自编住院患者健康行为规范,以5级评分法每周对患者进行评分,进行前后对照比较),连续进行8周。并采用护士用住院患者观察量表于入组前和入组后8周对全部患者进行测评,比较两组同期评分;护士用住院患者观察量表的总积极因素分(社会能力、社会兴趣、个人整洁)和病情总估计分越高,总消极因素分(激惹、精神病表现、退缩、抑郁)越低,患者的行为和社会功能缺陷改善越大。结果:观察组患者7例,对照组8例因提前出院而脱落,脱落率为6.25%。完成治疗和测评者,观察组113例,对照组112例共225例纳入结果分析。①观察组住院患者健康行为规范评分第2～8周分别与第1周比较,差异均有显著性意义(2.09±0.66,2.43±0.71,2.92±0.68,3.31±0.71,3.67±0.70,4.06±0.67,4.40±0.68,1.45±0.61,t=12.14,16.66,22.46,30.00,31.87,38.94,39.52;P<0.01)。②观察组经健康教育8周后护士用住院患者观察量表的社会能力、社会兴趣、个人整洁、总积极因素、病情总估计分、激惹、总消极因素减分值均高于对照组(37.15±3.37,31.32±7.83;18.37±8.67,12.01±7.89;29.41±2.93,20.16±7.45;91.29±68.40,63.19±14.31;199.60±21.13,174.19±23.31;5.20±5.66,12.08±12.63;13.33±13.66,21.05±17.89;t=7.25,5.74,12.27,4.25,8.56,5.28,3.62,P<0.01)。结论:通过健康教育和行为矫正训练,观察组精神分裂症患者的住院患者健康行为规范每周评分均逐步提高,且护士用住院患者观察量表的社会能力、社会兴趣、个人整洁、总积极因素、病情总估计分、激惹、总消极因素减分值均高于对照组,提示健康教育和行为矫正训练可改善精神分裂症患者的不良行为,而非改善精神症状。

AIM： To investigate the effect of health education and behavior modification based on drug therapy on the vicious behavior of patients with schizophrenia. METHODS： Between July 2003 and December 2004, totally 240 inpatients with schizophrenia, who were in accordance with the Chinese Classification and diagnostic criteria of Mental Disorders （CCMD）, in the four disease areas of Guangzhou Psychiatric Hospital were divided in to observational group （n=120） and control group （n=120）, half males and half females. All the patients received antipsychiatric drug therapy and routine nursing care, besides, those in the observational group received health education （① The nurses publicized the general knowledge of mental health to the patients every week. ② The effect of behavior modification training was reinforced, positive encouragement was given, and the score was summarized once a week.）and behavior modification training（The healthy behavior modification of the patients was compiled, and the patients were scored by 5 grades every week, and they were compared before and after training） for 8 weeks. The nurses＇ observation scale for inpatient evaluation （NOSIE） was used to evaluate all the patients before grouping and 8 weeks after grouping, and the scores at the same period between the two groups. The higher the total score of positive factors （social ability, secial interest, individual tidiness） and total estimated score of disease condition, and the lower the total score of negative factors （agitation, psychiatric manifestation, withdrawal, depression）, the greater the improvement of the behavior and social functional deficits. RESULTS： Seven cases in the observational group and 8 cases in the control group lost because they went out of hospital ahead of schedule, the withdrawal rate was 6.25%. Finally 225 cases （113 in the observational group and 112 in the control group） finished the treatment and evaluation, and involved in the analysis of results. ① In the observational group, the scores of behavior modification at 2-8 weeks were significantly different from that at the 1^st week （2.09±0.66, 2.43±0.71, 2.92±0.68, 3.31±0.71, 3.67±0.70, 4.06±0.67, 4.40±0.68, 1.45±0.61, t=12.14, 16.66, 22.46, 30.00, 31.87, 38.94, 39.52; P〈0.01）. ② The scores of social ability, social interest, individual tidiness in NOSIE, total estimated score of disease condition, agitation, decreased total score of negative factors at 8 weeks after health education were all higher in the observational group than in the control group （37.15±3.37, 31.32±7.83; 18.37±8.67, 12.01±7.89; 29.41±2.93, 20.16±7.45; 91.29±68.40, 63.19±14.31; 199.60±21.13, 174.19±23.31; 5.20±5.66, 12.08±12.63; 13.33±13.66, 21.05±17.89; t=7.25, 5.74, 12.27, 4.25, 8.56, 5.28, 3.62, P〈0.01）. CONCLUSION： After health education and behavior modification training, the weekly score of healthy behavior modification in the observational group was increased gradually,and the scores of social ability, social interest, individual tidiness in NOSIE,total estimated score of disease condition, agitation, decreased total score of negative factors were all higher than those in the control group, indicating that health education and behavior modification training can ameliorate the vicious behavior but not the psychiatric symptoms in the patients with schizophrenia.