代币强化法对精神分裂症伴2型糖尿病患者良性行为依从性的影响

Effects of tokens reinforcement method on good behaviors compliance for schizophrenia patients with type 2 diabetes

目的探讨代币强化法对精神分裂症合并2型糖尿病患者良性行为依从性的影响,为更有效地控制血糖、提高治疗效果提供依据。方法 2012年9月至2014年3月,选取杭州市第七人民医院老年精神科住院的64例恢复期精神分裂症合并2型糖尿病患者为研究对象,分为干预组（33例）和对照组（31例）。对照组给予一般的健康教育及常规的行为管理;制定对糖尿病非药物治疗的良性行为标准,对干预组患者的良性行为采用代币强化方法进行训练,用4级评分法评价良性行为的依从性,采用SPSS 13.0软件对数据进行统计分析,对两组患者治疗前后的良性行为依从性以及生化指标的检测用χ~2检验或t检验。结果干预前,两组患者良性行为依从性比较,差异无统计学意义（P〉0.05）,干预组3个月后良性行为依从性较对照组提高,差异有统计学意义（P〈0.01）。两组间比较,干预前、治疗1个月空腹血糖（FPG）、餐后2 h血糖（2 h PG）和糖化血红蛋白（Hb A1C）差异均无统计学意义（P〉0.05）。3个月后,干预组FPG﹑2 h PG﹑Hb A1C均明显低于对照组,差异均有统计学意义（t值分别为3.171、2.340和6.445,P〈0.01）。结论代币强化法能有效地提高精神分裂症合并2型糖尿病患者良性行为依从性,进而可能有助于更好地控制血糖,提高治疗效果。

Objective To explode the effects of tokens reinforcement method on good behaviors compliance for schizophrenia patients with type 2 diabetes and to provide the basis for controlling blood glucose and increasing the therapy effects of schizophrenia patients. Methods The subjects were 64 recovery phase schizophrenia inpatients with type 2 diabetes in the people＇s seventh hospital of Hangzhou during September 2012 to March 2014. The subjects were divided into intervention group （33 cases） and control group （31 cases）. The control group was treated with the health education and routine behavior management. The intervention group was treated with tokens reinforcement method for training the good behavior compliance. The four level grade score method was used to evaluate the good behaviors compliance. Before and after treatment, the good behaviors compliance assessment and blood test （fast plasma glucose, FPG; postprandial 2 h blood glucose, 2 h PG; and HbAlc） were conducted for all subjects. All data were analyzed using SPSS 13.0 software with X2 test and t test. Results Before treatment, there was no significant difference of good behavior compliance between two groups （P〉0.05）. In 3 months after treatment, the good behavior compliance of intervention group was significantly better than that of control group （P〈0.01）. Before treatment and 1 month after treatment, there were no significant diffences of FPG, 2 h PG and HbAlc between two groups （P〉0.05）. In 3 months after treatment, the decreasing levels of FPG, 2 h PG and HbAlc of intervention group were significantly better than those of control group （P〈0.01）. Conclusion Tokens reinforcement method is a practical way to enhance the good behavior compliance and management of blood glucose in schizophrenia patients with type 2 diabetes.