综合技能训练对精神分裂症康复效果2年随访研究

Two-year Follow-up Study on the Rehabilitation Efficacy of Comprehensive Skills Training on Schizophrenics

目的探讨综合技能训练对精神分裂症患者康复效果的影响。方法 120例符合DSM-Ⅳ和CCMD-3诊断标准的住院精神分裂症患者,随机分为综合技能训练组(综合组)和对照组各60例,综合组进行为期3个月的综合技能训练,对照组接受常规药物治疗。入组时和3月后采用日常生活能力量表(ADL)、精神病人康复疗效评定量表(IPROS)、社会功能缺陷量表(SDSS)进行评定,然后进行为期2年的随访,比较两组服药依从性、复发率和再住院率的差异。结果①综合组完成52例,对照组完成56例。综合组训练3月后比训练前IPROS总分(t=7.68,P<0.05)及生活能力(t=4.22,P<0.05)、社交能力(t=3.98,P<0.05)、讲究卫生(t=3.85,P<0.05)、关心兴趣(t=4.26,P<0.05)4个因子评分比较,经配对t检验差异均有统计学意义,但工作能力因子评分差异无统计学意义(t=1.43,P>0.05)。对照组IPROS总分及各因子评分3月前后差异均无统计学意义;②综合组入组时和3月后ADL的躯体生活自理量表(t=4.65,P<0.05)和工具性日常生活自理量表(t=4.86,P<0.05)、SDSS(t=8.84,P<0.05)评分比较,经配对t检验差异均有统计学意义;对照组入组时和3月后各量表评分比较,经配对t检验差异均无统计学意义;③服药依从性综合组(完全依从63.5%,部分依从15.4%,不依从21.1%)和对照组(26.8%,35.7%,37.5%)比较,差异有统计学意义(χ2=22.686,P<0.01)。复发率和再住院率比较,综合组复发率17.3%,再住院率11.5%,对照组复发率39.3%,再次住院率28.6%,差异有统计学意义(复发率χ2=24.872,P<0.001;再住院率比较,Fisher精确概率,P<0.001)。结论综合技能训练可提高精神分裂症病人的康复效果,提高依从性,降低其复发率和再住院率。

Objective To explore the efficacy of comprehensive skills training on the schizophrenics. Methods A total of 120 schizophrenics who met with DSM- IV and CCMD- S criteria were divided randomly into comprehensive skills training group （comprehensive group）（n= 60）and control group （n： 60）. Comprehensive group received comprehensive skills training for three months, control group received routine drug treatment. Two groups were assessed with activity of daily living scale （ADL）, schizophrenic rehabilitation therapeutic effect rating scale （IPROS）and social disability screening schedule （SDSS）in baseline and af- ter three months. Then two groups were followed up for two years and were assessed about medication compliance ,relapse rate and readmission rate. Results ① There were significant differences in IPROS total scores（t = 7.68,P〈0. 05） and the scores of the following four factors life ability（t= 4. 22,P〈0.05）,sociability（t= 3.98,P〈0. 05）,individual hygiene（t= 3.85,P〈0. 05）,con- cern and interest （t = 4.26, P〈0.05）in the baseline and after three months in comprehensive group. There were no significant dif- ferences in the changes of the scores of factor work ability（t： 1.43 ,P〈0.05）. There were no significant differences in the changes of IPROS total scores and all factors scores between the baseline and after three months in control group. ②There were significant differences in the scores of physical self-maintenance scale （PSMS）（t： 4.65,P〈0.05）and instrumental activities of daily living scale （ADL）（t= 4.86,P〈0. 05）and SDSS （t： 8.84,P〈0.05）between baseline and after three months in comprehensive group. There were no significant differences in all scales scores between the baseline and after three months in control group.③There were significant differences in medication compliance between comprehensive group（complete compliance rate 26.8% ,partial compliance rate 35.7 % ,poor compliance rate 21.1 % ）and control group （complete compliance rate 63.50% ,partial compliance rate 15.4 %,poor compliance rate 37.5 % ）（Z2= 22. 686 ,P〈0. 05）. There were significant differences in relapse rate and readmission rate （all P〈 0. 05） between two groups. Conclusion The comprehensive skills training can be used to promote the rehabilitation efficacy of the schizophrenics and enhance the medication compliance and degrade the relapse rate and readmission rate.