阴性症状对精神分裂症患者社会功能改善的预测作用

Negative Symptoms Predict the Improvement of Social Functioning of Patients with Schizophrenia

目的研究社区康复期精神分裂症患者社会功能改善的影响因素、预测因素。方法应用一般资料调查表、阳性和阴性症状量表(PANSS)、个人与社会表现量表(PSP)、自尊量表(SES)、家庭关怀量表(APGAR)、世界卫生组织残疾评定量表第二版(WHODAS-Ⅱ)对101例社区康复期精神分裂症患者进行基线和6个月后的测评,采用Pearson相关分析和分层多元线性回归分析,分析患者6个月社会功能改善的影响因素和预测因素。结果患者社会功能改善与首发年龄(r=0.220)、阴性症状减分值(r=0.468)、一般病理症状减分值(r=0.392)、PANSS总分减分值(r=0.472)和WHODAS-Ⅱ减分值(r=0.247)相关(P均<0.05);社会功能改善的主要预测因素按作用大小依次为:阴性症状减分值〔决定系数变化(ΔR2)=0.197〕、首发年龄(ΔR2=0.048)、WHODAS-Ⅱ减分值和精神康复干预(ΔR2=0.031)。结论阴性症状改善是社区康复期精神分裂症患者短期社会功能改善的最大预测因素。

Objective To identify predictive factors associated with the improvement of social functioning of schizophrenia patients in a community. Methods 101 schizophrenia patients undergoing community rehabilitation were assessed with the Positive and Negative Syndrome Scale （PANSS）, Personal and Social Performance Scale （PSP）, Self-Esteem Scale （SES）, Family Function Questionnaire （APGAR）, and the World Health Organization Disability Assessment Scale II （WHODAS-II ） twice 6 months apart. Pearson correlation and hierarchical multiple linear regression analyses were performed to identify the influencing and predictive factors associated with the improvement of social functioning. Results The increase of PSP score was correlated with age （r=0. 220）, reduced PANSS negative score （r=0. 468）, reduced PANSS general score （r=0. 392）, reduced PANSS total score （r= 0. 472）, and reduced WHODAS-II Score （r=0. 247）. The predictive factors of the change of PSP score followed the following order： change of PANSS negative score [the change of coefficient of determination （△R2） = 0. 197], age of onset （△R2=0. 048）, change of WHODAS-lI score and psychiatric rehabilitation （△R2 =0. 031）. Conclusion Improvement of negative symptoms predicts the short-term improvement of social functioning of schizophrenia patients.