重性精神病患者及其家属病耻感调查与干预

Severe Mental Illness Stigma Investigation and Intervention

目的掌握重性精神病患者和家属病耻感的实际情况,探讨减少患者和家属病耻感的有效办法。方法从常住户籍在阳江市阳东县和江城区,参与医院、社区一体化管理,符合中国精神障碍分类与诊断标准第3版(CCMD-3)及重性精神疾病概念范围的2 358例患者中,随机抽出130例患者作为调查干预对象。采取心理行为干预办法,强化家庭内部治疗。采用自拟病耻感调查表观察患者病耻感、服药依从性、家属病耻感,服药依从性按规律、间断、不服药记录。采用SPSS 19.0统计软件比较干预前后观察指标的变化。结果干预前重性精神病患者及家属存在病耻感,分别是86.2%(112/130)和100.0%(130/130)。干预后,患者和家属的中、重度病耻感均明显减少、减轻,差异有统计学意义(P<0.01);患者服药依从性改善,差异有统计学意义(P<0.01)。结论重性精神病患者及家属病耻感情况严重,应引起各方面重视。对患者和家属进行心理行为干预,强化家庭内部治疗,可明显降低他们的病耻感,提高患者的服药依从性。

Objective This paper describes the situation of patients and their family＇s stigma and researches for effective methods of reducing the stigma of them. Methods Among 2 358 patients in Yangjiang City, Yangdong County and Jiangcheng District,who meet the standards of CCMD-3 and the concept of major psychosis by National Health and Family Planning Commission of the People＇s Republic of China,130 patients were investigated and intervened in patients and their family＇s stigma and medication compliance by self-prepared stigma questionnaire. Medication compliance was observed by the records of taking the drug contiguously,discontiguously or rejecting taking the drug. Psychological and behavioral intervention was adopted to strengthen the internal family therapy. And SPSS 19. 0 statistical software was used to observe the variations before and after intervention. Results The result showed that most patients and their family felt shame,respectively 86. 2%（ 112 /130） and 100. 0%（ 130 /130）. After intervention,most moderate and sever psychotics and their family＇ stigma was obviously reduced（ average P〈0. 01）. Medication compliance of patients was significantly improved（ P〈0. 01）. Conclusion The authors suggest that the austere situation of the severe mental illness patients and their family should arouse public attention. Also,intervene in the patients and their family＇ s psychological behavior can not only considerately reduce their stigma,but also improve their drug compliance.