抗精神病药单用与结合心理社会干预对非慢性精神分裂症患者一年结局的影响

Antipsychotic alone versus combined with psychosocial intervention on one-year outcome in non-chronic schizophrenia

目的比较抗精神病药单用与结合心理社会干预对非慢性精神分裂症患者1年结局的影响。方法多中心随机对照研究，将1239例病程≤5年、稳定期的精神分裂症患者随机分为单纯药物治疗组（以下简称药物组，635例）和药物结合心理社会干预组（以下简称干预组，604例）治疗随访1年。心理社会干预包括健康教育、家庭干预、技能训练及认知行为治疗。主要结局指标为各种原因造成的治疗中断率、疾病复发率和再入院率；次要结局指标为自知力与治疗态度问卷（ITAQ）、健康状况问卷（SF-36）、大体评定量表（GAS）和社会功能缺陷筛选量表（SDSS）评分的变化。结果（1）干预组和药物组总的治疗中断率分别为32．8％和46．8％[相对危险度（RR）=1．61]，复发率分别为13．8％和21．3％（RR=1．76），再入院率分别为6．5％和11．2％（RR=1．99），差异均有统计学意义（P均〈0．01—0．05）。（2）干预组ITAQ总分变化值[（4．7±0．1）分]、6项SF-36因子分改善值、GAS总分变化值[（6．9±0．2）分]、SDSS总分变化值[（1．5±0．1）分]均明显高于药物组[分别为（1．5±0．1）分、（3．7±0．2）分、（1．0±0．1）分；P均〈0．01—0．05]。结论抗精神病药结合心理社会干预治疗非慢性精神分裂症患者，中断率、复发率和再入院率均低于单用抗精神病药患者，自知力、治疗依从性、生活质量、社会功能的改善优于单用抗精神病药患者。

Objective To compare effectiveness of antipsychotic alone versus combination with psychosocial intervention on one-year outcomes in non-chronic schizophrenia. Methods One thousand two hundred and thirty nine stable schizophrenic patients with illness duration of less than 5 years were randomly assigned to receive medication treatment alone （635 cases） or medication combined psychosocial intervention （604 cases） for twelve months. The psychosocial intervention consisted of psycho-education, family intervention, skills training and cognitive-behavioral therapy. The main outcome measures were the rates of discontinuation due to any cause, relapse or re-hospitalization. Secondary outcomes were assessed by the Insight and Treatment Attitudes Questionnaire （ITAQ）, Medical Outcome Study Short-Form 36-item questionnaire （ SF-36）, Global Assessment Scale （GAS） and Social Disability Screening Schedule （SDSS）. Results The rate of discontinuation treatment due to any cause was 32. 8% in combined treatment group and 46. 8% in medication treatment alone group, and the difference between two groups was significant （ P 〈 0. 01 -0. 05 ）. The rate of relapse was 13.8% in combined treatment group and 21.3 % in medication treatment alone group. Mean change of ITAQ scores was more in combined treatment than in medication treatment alone （ P 〈 0.01 ） . Patients receiving combined treatment showed greater improvement in 6 domains of SF-36 （P 〈0. 01 -0. 05）. Mean change of SDSS score was more in combined treatment than in medication treatment alone （ P 〈 0. 01 ） . Conclusion In non-chronic patients with schizophrenia, antipsychotic combined with psychosocial intervention is useful to improve insight and treatment adherence, quality of life and social function and prevent relapse.