药物-心理-社会综合干预模式对精神分裂症患者结局的疗效

The effect of drug-psychological-social comprehensive intervention model for the overall outcome of schizophrenic patients

目的验证药物-心理-社会综合干预模式对精神分裂症结局的疗效。方法将济宁市精神病防治医院2010年1月至2012年6月收治的200例符合美国精神病学会制定的《诊断与统计手册:精神障碍(第4版)》(DSM-Ⅳ)和《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)诊断标准的精神分裂症患者随机分为两组,一组实施药物-心理-社会综合干预模式(综合组),另一组实施常规抗精神病药物治疗,不进行心理-社会干预。干预3个月并随访1年,对两组的阳性与阴性症状量表(PANSS)、大体评定量表(GAS)、社会功能缺陷筛选量表(SDSS)及健康状况问卷(SF-36)评分情况进行比较。所有数据采用统计学软件SPSS 16.0进行统计学处理。结果 (1)随访1年后,综合组的总治疗中断率为14%(14例),对照组为32%(32例)(χ2=9.147,P<0.01);复发率综合组为12%(12例),对照组为24%(24例)(χ2=4.878,P<0.01);治疗依从性差或违背治疗方案率综合组为6%(6例),对照组为13%(13例)(χ2=3.843,P<0.05);再入院率综合组为6%(6例),对照组为13%(13例)(χ2=3.843,P<0.05);自杀率(包括自杀行为、自杀未遂和自杀死亡)综合组为5%(5例),对照组为12%(12例)(χ2=3.846,P<0.05);再就业或入学率综合组为32%(32例),对照组为18%(18例)(χ2=5.227,P<0.01)。(2)随访1年综合组PANSS、GAS、SDSS评分变化与对照组比较差异有统计学意义(t=5.634,P<0.01,t=7.268,P<0.01,t=3.8365,P<0.05)。(3)随访1年综合组和对照组SF-36总分及各因子分比较差异均有统计学意义(P<0.05或P<0.01)。结论药物-心理-社会综合干预模式能显著改善精神分裂症的总体结局和生活质量,值得临床推广使用。

Objective Ta verify the effect of drug-psychological-social comprehensive intervention model for the overall outcome of schizophrenic patients. Methods Two hundred schizophrenic patients who met with diagnostic and statistical manual of mental disorders （ DSM-IV ） and chinese classfication and diagnostic criteria of disorders Ⅲ（ CCMD-Ⅲ ） criteria were divided randomly into comprehensive group（ n = 100） and control group （ n = 100）. Comprehensive group received drug-psychological-social comprehensive intervention for three monthes, control group received routine drug treatment. Two groups were followed up for one year, the scores of positive and negative syndrome scale （ PANSS）, global assessment scale （ GAS）, social disability screening schedule （SDSS） and the MOS item short from health survey （SF-36） in the two groups were compared. All data were processed by SPSS 16.0 statistically. Results （1）There were significant differences in the following indexes between two groups such as discontinuation rate（ 14% vs 32%, X2 =9. 147, P 〈0.01 ）, relatpse rate（ 12% vs 24%, X2 =4. 878, P 〈0.01 ）, poor compliance rate（6% vs 13% ,X2 = 3. 843, P 〈 0.05 ） , hospital readmission （ 6% vs 13%, X2 = 3. 843, P 〈 0.05 ） ; suicide rate （include suicide behavior, suicidal attempt and complete suicide, 5% vs 12%, g2 = 3. 846, P 〈 0.05 ） ; reemployment or return to school （ 32% vs 18% , X2 = 5. 227, P 〈 0. O1 ）. （ 2 ） There were significant differences in the changes of the the following three scales of PANSS, GAS and SDSS between two groups（ t = 5. 634, P 〈 O. 01, t = 7. 268, P 〈 0. 01, t = 3. 836, P 〈 0. 05 ）. （3） There were significant differences in the total scores and factor scores of SF-36 between two groups （ P 〈 0.05 or P 〈 0.01 ）. Conclusion Drug- psychological-social comprehensive intervention model was effective for the overall outcome and the quality of life of schizophrenic patients, thus worth being popularized in clinical psychiatry.