定期心理治疗对社区精神分裂症伴抑郁情绪患者的干预效应:1年随访

Interventional effect of regular psychological therapy on the improvement of schizophrenia accompanied by depressive mood in the community: one-year follow-up

目的:探讨定期心理干预对改善精神分裂症患者抑郁情绪和工作能力及降低复发率的作用。方法:观察对象为1998-06/2002-12经住院治疗达“临床无症状”并回归社区的合并抑郁情绪、且于2001-01/2003-01能每月1次定期门诊随访达2年的精神分裂症患者200例。随机数字表法分成干预组和对照组,每组100例。对照组给予常规抗精神病药治疗,干预组则在常规药物治疗基础上,进行定期心理干预,心理干预内容:①心理疏导。②用药指导。③家庭气氛干预。④指导患者提高社会功能。⑤上门干预进行心理疏导或提供热线电话咨询。1年后行Zung抑郁自评量表和汉密顿抑郁量表评定,同时进行工作能力恢复程度和复发率的比较。规定经治疗后评定为“临床无症状”者3个月再度出现精神症状为复发。工作能力恢复程度包括恢复到原来工作、胜任一般工作、经督促能工作、不能工作4种。自评抑郁量表由20个陈述句和相应问题条目组成。按1～4级评分。汉密顿抑郁量表由24个项目构成,采用0～4分的5级评分法。测评时由专职人员采用统一指导用语,严格按常规完成。抑郁自评量表和汉密顿抑郁量表评分越高,抑郁情绪越严重。结果:随访时间1年,干预组和对照组患者均无脱落,并全部完成量表测评进入结果分析。①干预组复发24例(24%),对照组复发39例(39%),对照组患者复发率显著高于干预组,差异有显著性意义(χ2=5.213,P<0.05)。②干预组工作能力恢复程度较对照组为好,尤以恢复到原来工作能力项显著(33/33.0,19/19.0,χ2=5.093,P<0.05);工作能力受损则是干预组较对照组为低,尤以不能工作项显著,但两组间差异无显著性意义(P>0.05)。③两组患者入组时均具抑郁情绪,但抑郁自评量表和汉密顿抑郁量表评分差异无显著性意义。1年后,两组患者抑郁情绪有改善,抑郁自评量表和汉密顿抑郁量表评分较入组时均有降低,差异有显著性意义(P<0.01),但经过1年心理干预的干预组患者抑郁自评量表和汉密顿抑郁量表评分比对照组降低更为明显,差异有显著性意义[(30.12±3.42),(39.33±5.52),t=5.86,P<0.01];[(14.53±4.16),(21.72±5.56),t=5.26,P<0.01]。结论:定期心理干预有利于改善精神分裂症患者的抑郁情绪,降低复发率和提高社会功能。

AIM： To investigate the effect of regular psychological intervention in the improvement of depressive mood, working ability and relapse rate of schizophrenic patients. METHODS： 200 schizophrenics who had no clinical symptoms after hospitalization between June 1998 and December 2002 and had depressive mood as well as could get back to the consult clinic of community once a month for 2 years between January 2001 and January 2003 were selected and randomly divided into intervention group and control group with 100 cases in each group. Patients in the control group were given of routine antipsychotic drugs, while patients in the intervention group were given of regular psychological intervention based on routine antipsychotic drugs with the contents of：①psychological nursing.②instructions on medication. ③Intervention of family atmosphere.④Instruction on patients about enhancing social function. ⑤Door-to-door intervention by psychological nursing or consultation through telephone. One year after that, patients were evaluated by Zung Self-rating Depression Scale （SDS） and Hamilton rating scale for depression （HAMD）, meanwhile, the degree of recovery and relapse rate of working ability were compared. It was regulated that patients who were assessed as having no clinical symptoms recurred at 3 months later were taken as recurrence. The recovery degree of working ability included four kinds： recovered to the original ability, being competent for normal jobs, able to work under supervising and unable to work. There were 20 items of statements and corresponding questions in SDS, and there were 4 grades. HAMD was composed of 24 items with 5 grades ranging from zero to 4 points. The assessment was strictly conducted by special personnel under unified instrocting language according to the routine. The higher the score of HAMD and SDS were, the severe the depressive mood was. RESULTS： During one-year follow-up, no one of both groups withdrew from the study, and all subjects accomplished the assessment of scales and were involved in the analysis of results.①There were 24 patients （24%） in the intervention group and 39 patients （39%） in the control group recurred, and the relapse rate in patients of control group was significantly higher than the intervention group （x^2=5.213,P 〈 0.05）.②The recovery of working ability of the intervention group was better than the control group, especially in recovering to original ability （33/33.0,19/19.0,x^2=5.093 ,P 〈 0.05）. The damage of work ability was lighter in the intervention group than in the control group, especially on item of unable to work, and the differences between two groups were not remarkable （P 〈 0.05）.③Patients in both groups all had depressive mood when grouping, while the differences in scores of HAMD and SDS were not significant. One year later, the depressive mood of patients in both groups were ameliorated, and the scores of HAMD and SDS were remarkably lower than grouping （P 〈 0.01）, while after one-year psychological intervention, the scores of HAMD and SDS in patients of intervention group were obviously decreased than control group [（30.12±3.42）, （39.33±5.52）, t=5.86,P 〈 0.01] ;[（14.53±4.16）, （21.72 ±5.56） ,t=5.26,P 〈 0.01]. CONCLUSION： Regular psychological intervention is helpful to the improvement of depressive mood in schizophrenics, which can also reduce the relapse rate and enhance the social function.