综合康复治疗对社区慢性精神分裂症患者认知功能影响的3年随访

Three years follow-up study of efficacy of rehabilitation treatment on cognitive function in patients with chronic schizophrenia in the community

目的探讨社区治疗及家庭心理治疗的综合康复治疗模式对社区慢性精神分裂症患者认知功能的影响。方法采用随机抽样法,将98例上海市普陀区社区慢性精神分裂症患者随机分为干预组(48例)和对照组(50例),在维持原有抗精神病药物治疗的同时,由专职精神科医师和经过专业培训的社区工作者对干预组组织社区治疗并进行定期综合心理教育式家庭干预,对照组仅为上门随访。于入组前及第3年末分别对两组患者进行阳性症状与阴性症状量表(PANSS)评定精神症状、MorningSide康复状态量表(MRSS)评定康复状态、韦氏成人智力测验(WAIS-RC)、简易精神状态检查表(MMSE)、威斯康星卡片分类试验(WCST)测定患者认知功能水平。随访3年。结果观察前后干预组在PANSS总分[(47.43±12.62)与(42.38±11.40),t=8.89,P=0.001]、MRSS总分[(48.60±2.99)与(40.46±3.47),t=7.696,P=0.002]、MMSE[(19.54±2.99)与(23.68±1.42),t=3.684,P=0.005]、WCST总测验数[(87.76±20.54)与(80.08±21.33),t=3.431,P=0.003]等存在统计学差异(P<0.05)。结论社区治疗及家庭心理治疗的综合康复治疗模式对社区慢性精神分裂症患者的阴性症状,认知功能尤其是执行功能具有明显改善。

Objective： To study the efficacy of rehabilitation treatment on cognitive function in patients with chronic schizophrenia in the community. Methods： 98 chronic schizophrenias in Putuo district were selected and randomly assigned into the intervention group （ n = 48 ） and the control group （ n = 50）. All the case were assigned to receive drug treatment. The intervention group were provided integrative mental health education and family intervention by psychiatrists every month, while the cases in control group were only followed by regular clinic visits. The results were assessed at baseline, end of the 3rd year, which including relapses of psychotic symptoms, Scale（ WAIS）, Mini -mental State Examination（MMSE） and Wisconsin Card Sorting Test （WCST）, Morning Side Rehabilitation Stats Scale （MRSS） were used to measure therapeutic efficacy, side effects and cognitive function for 3 years. Results： The total scores [ （47.43 ± 12.62 ） vs. （ 42.38 ± 11.40 ）, t = 8.89, P = 0.001 ] and negative symptoms factor scores [ （ 15.17 ± 2.29 ） vs. （ 12.48 ± 3.40 ）, t = 2.035,P = 0. 037 ] of PANSS, MRSS [ （48.60 ± 2.99） vs. （ 40.46 ± 3.47）, t = 7. 696, P = 0. 002 ] , MMSE scores [ （ 19.54 ± 2.99 ） vs. （ 23.68 ± 1.42 ）, t = 3. 684,P = 0.005 ] and WCST scores [ （ 87.76 ± 20.54） vs. （ 80.08 ± 21.33 ）, t = 3. 431, P = 0. 003 ] decreased significantly after the intervention group. Conclusion： Rehabilitation treatment can improve negative symptoms and cognitive impairment of chronic schizophrenia in the community.