恢复期精神分裂症患者的生活技能训练

Life skill training in patients with schizophrenia during recovery phase

目的:分析如何对出院后精神分裂症患者进行康复训练并形成行之有效的操作体系,同时分析训练效果。方法:选择2005年在四川大学华西医院心理卫生中心参加康复训练的总病程少于5年的门诊恢复期精神分裂症患者38例为观察对象。进行系统康复训练,内容包括:“生存”能力训练、问题解决训练、认识自我的训练、同理能力的训练。采用小组训练的方法,患者和监护人均自愿参加,前3个月每月训练1次,以后每3个月训练1次。训练总时间2～9个月,完成小组集中训练2～5次,平时个别训练由家属监督进行。采用日常生活能力量表对康复效果进行评价。每次训练前由监护人和患者共同评定。日常生活能力量表由躯体生活自理量表和工具性日常生活活动量表组成,共有14项,采用4级评分。总分最低16分,为完全正常,大于16分表示有不同程度的功能下降,最高64分。单项分1分为正常,2～4分为功能下降。凡有2项或2项以上≥3分,或总分≥22分,为功能有明显障碍。结果:因入组时间前后不同,第一次参与训练38例,第二次参与训练33例,第三次参与训练27例,第四次参与训练12例,第五次5例,均进入结果分析。①干预后日常生活能力量表评分总分下降明显;工具性日常生活能力分量表分下降,差异有显著性(P<0.05);躯体生活自理分量表分无明显改变。②第一次训练后38例患者中有5例日常生活能力量表评分总分≥22分;第二次训练后33例患者中有4例日常生活能力量表评分总分≥22分;第三次训练后26例患者中有1例日常生活能力量表评分总分≥22分;第四、五次训练后患者中没有日常生活能力量表评分总分≥22分者。5次测定结果经分布检验:χ2=3.907,P>0.05。即5次测定每次总分≥22分的人数分布没有差别。③5次测定量表项目评分≥3分的项目全部集中在做饭菜、做家务、洗衣、处理钱财4个方面。结论:恢复期精神分裂症患者生活自理缺陷主要集中在工具性生活能力方面。通过生活技能训练,在短期内能取得良好的效果。同时,应该强调个性化的训练方式和家属的积极参与及监督。

AIM： To analyze how to perform rehabilitation training and form effective operation system in patients with schizophrenia after discharge and to analyze the training result. METHODS： Totally 38 patients with schizophrenia in recovery phase with the whole course less than 5 years, who participated in rehabilitation training, were collected from Mental Health Center, West China Hospital, Sichuan University in 2005. Systemic life skill training was conducted in groups. The training included survival training, problem solving, self-awareness and empathy. The patients and their guardians participated in the training voluntarily, once a month in the first 3 months and later once three months. The total period was for 2-9 months, which included 2-5 times group therapies. Normally individual training was performed by surveillance of family members. Activity of Daily Living Scale （ADL） was used to evaluate the effectiveness of rehabilitation. Before the training, the assessment was done by guardian and patients. The scale was composed of Physical Self-maintenance Scale （PSMS） and Instrumental Activities of Daily Living Scale （IADL）, totally 14 items, 4 grades. The lowest total score was 16 points, completely normal; over 16 points represented with functional reduction to different degree; the highest score was 64 points. One point was as normal and 2-4 points as functional reduction in single item. Scores of 2 items or over 2 items were at least 3 points, or the total score of at least 22 points indicated significantly functional disturbance. RESULTS： Because of the different time of entering groups, 38 patients participated in the first training, 33 in the second training, 27 in the third training, 12 in the fourth training and 5 in the fifth training, and they all were involved in the result analysis. ① After intervention, the total score of ADL decreased significahtly; Score of IADL decreased, and the difference was significant （P 〈 0.05）. Score of PSMS did not change obviously. ② Of the 38 patients, total score of ADL in 5 patients was at least 22 points after the first training, 4 patients of the 33 patients after the second training, 1 patient of the 26 patients after the third training, none after the fourth and fifth trainings. The results of the 5 determinations were checked by distribution test （χ^2=3.907, P 〉 0.05）, which indicated that there was no significant difference in the number of patients with total score of at least 22 points every time in the 5 determinations. ③ The items of at least 3 points focused on cooking, housework, clothing washing, financial arrangement. CONCLUSION： Life skill deficits in patients with schizophrenia in recovery phase mostly focus on instrument life skill. It may have good effectiveness in a short period through life skill training. Meanwhile, it should emphasize individualized training approach, their families＇ participating and guardians.