缓解期精神分裂症患者的病耻感及住院态度

Stigma and attitude towards hospitalizations from patients with schizophrenia in remission

目的 通过对缓解期精神分裂症患者病耻感及对住院态度的调查,分析缓解期精神分裂症的病耻感特点,不同治疗方式和环境对精神分裂症病耻感的影响,为减轻病耻感,提高治疗效果提供依据.方法 对浙江同德医院门诊或住院治疗的缓解期精神分裂症患者120例进行人口学特征、BPRS、CGI-SI、SSMI-C、TESS和自制的对住院态度问卷进行测量和评估,分析比较门诊或住院患者缓解期病耻感特点.结果 调查发现缓解期精神分裂症患者普遍存在被歧视、自我感觉的病耻感及对疾病的掩饰性,其中与门诊组患者比较,住院组患者的歧视因子较高,积极效应因子评分较低,两组比较差异有统计学意义（P＜0.01）;住院组患者对被欺骗、强行住院、强行治疗和被搜身等抵抗态度的发生率明显高于门诊组,两组比较差异有统计学意义（P＜0.05）.结论 门诊治疗对患者产生病耻感的影响较小,对积极效应影响小.住院患者被强制住院、强制治疗、限制自由均加重患者对住院治疗的抵抗和病耻感,采取积极有效的治疗模式或改善住院环境可能对减轻病耻感、提高生活质量有积极作用.

Objective To study the stigma characteristics of patients with chizophrenia in remission and the effect of various therapies and environment on the stigma. Methods Totals of 120 remitted psychiatric outpatients and inpatients of Tongde Hospital of Zhejiang province were surveyed with Brief Psychiatric Rating Scale （BPRS）, Clinician＇s Global Impressions--Severity of Illness scale （CGI--SI）, the Scale of Stigma in People with Mental Illness（SSMI--C）, Treatment Emergent Symptom Scale （TESS）, and the self--designed scale of attitude assessment towards hospitalization. Results There were pervasive dis- criminations, self--stigma and dissimulation in schizophrenics in remission. There were no significant difference in the factor of dissimulation between outpatients and inpatients （P 〈 0.05）. There were sig nificant difference in the factor of discriminations and positive coping between outpatients and inpatients （P 〈0.05）. And there were significant difference in the total scores of the self--designed scale of attitude to hospitalization between outpatients and inpatients （P 〈 0.05）. Conclusions Psychiatric outpatients have less stigma and more positive coping. Psychiatric inpatients who have been forced to be in hospital or to be in treatment or to be in restriction have more stigma and less positive coping. A pragmatic approaches should be adopt to optimize therapeutic methods and improve the environment of hospital.