精神病病人的自知力研究

A study of the insight assessment in psychiatric patients

为了解精神分裂症和躁狂抑郁症病人自知力表现的异同，应用自知力评估量表比较精神分裂症和躁狂抑郁症住院病人６周治疗前后自知力的变化。结果：（１）精神分裂症病人自知力评分显著高于躁狂抑郁症组，主要表现在对症状缺乏认识，抑郁发作病人的自知力缺失主要表现在对症状的归因解释方面；（２）经过６周治疗，两组病人的自知力均有恢复，尤其是躁狂发作病人；（３）临床医师对自知力的判断与自知力评估量表结果的相符率为７５％～８９％。提示不同精神疾病的病人其自知力缺损的内容不完全一样，对治疗的反应也不完全一样。

The insight deficit was a more common symptom in patients with schizophrenia and affective disorder. This study compared the differences between schizophrenics and manic depressive patients with insight deficit and aimed at letting the psychiatrists draw attention to the importance of insight assessment in clinical practice. The scale to assess unawareness of mental disorder (SAUMD),The brief psychiatric rating scale (BPRS) and Hamilton depression scale (HAMD)were used to evaluate 111 schizophrenic and 47 manic depressive inpatients before and after treatment which lasted six weeks. The results showed as follows :(1)the rating scores of SAUMD in the schizophrenic group were higher than the affective disorder group ,which meaned to the severity of insight deficit was higher in schizophrenia, particularly in unawareness of the mental symptoms but, in the depressive disorder group unawareness of attribution to the symptoms was more obvious;(2)after 6 weeks of treatment, the awareness of personal illness had some significant improvement in both schizophrenic and manic depressive groups, especialy in the patients with manic episodes showed much more improvement; and (3)there was a good correlation between the psychiatrists evaluation and the ratings of SAUMD (the correlation rates being 75%～89%). As judged from the results of the study, the deficit of insight was evidently one of the most common mental manifestations in the psychiatric patients . The actual insight would consist of rather different dificit contents in the patients with different mental troubles and with variable treatment responses.