首发康复期精神分裂症患者心理防御机制﹑社会支持和家庭功能特征的研究

Psychological defense mechanism,social support and family functioning for first-episode schizophrenia patients in period of recovery

目的探讨首发康复期精神分裂症患者心理防御机制、社会支持、家庭功能的特征,为制定有效的综合康复计划提供理论基础。方法分别对首发康复期精神分裂症患者组(n=138)和健康对照组(n=150)采用心理防御机制、社会支持、家庭功能等问卷进行调查,并比较各量表间的得分的差异。结果 1患者组不成熟防御方式总分高于对照组[(4.36±1.03)vs.(3.35±0.95)],差异有统计学意义(t=2.278,P=0.035),其中投射、被动攻击、抱怨、幻想、分裂、退缩、躯体化等因子得分均较高,差异均具有统计学意义(t=2.157~3.503,P=0.003~0.042);中间型防御方式总分较高[(4.91±0.86)vs.(4.10±0.75)],差异有统计学意义(t=2.242,P=0.038),其中反向、解除、回避、利他、隔离、否认、交往倾向﹑期望等因子得分均较高,差异均具有统计学意义(t=2.125~4.465,P=0.001~0.048);患者组成熟防御方式总分较低[(4.89±1.30)vs.(6.04±1.29)],差异有统计学意义(t=2.142,P=0.046),其中压抑、幽默因子得分均较低,差异均有统计学意义(t=-8.946、-6.535,均P<0.001);2患者组社会支持量表总分低于对照组[(35.19±5.27)vs.(42.34±8.38)],差异有统计学意义(t=-5.238,P=0.001),其中主观支持、客观社会支持以及支持利用度因子得分均较低,差异具有统计学意义(t=-7.034^-2.864,P=0.000~0.004);3患者组的家庭功能总分高于对照组[(2.23±0.09)vs.(1.89±0.10)],差异有统计学意义(t=7.642,P<0.001),其中问题解决﹑沟通﹑角色﹑情感反应﹑情感介入﹑行为控制各因子得分均高于对照组,差异具有统计学意义(t=5.261~8.033,均P<0.001)。结论首发康复期精神分裂症患者的防御方式存在不成熟倾向,社会支持系统差且家庭功能有缺陷。

Objective To explore the characteristics of the psychological defense mechanisms, social support, and family functioning for first-episode schizophrenia patients in rehabilitation period and provide a theoretical basis for the develop- ment of effective and comprehensive rehabilitation plan. Methods Total 138 schizophrenia patients after atypical antipsy- chotie treatment in rehabilitation period（ schizophrenia group）, and 150 healthy people （control group） were assessed with defense style questionnaire（ DSQ）, social support rating scales（SSRS） and family assessment device （FAD）, and analyze the difference in all the questionnaires between the two groups. Results ①The total score of the immature mechanism in the schizophrenia group was significantly higher [ （4.36 ± 1.03 ） vs. （3.35 ± 0.95 ）, t = 2. 278,P = 0. 035 ], the scores of projection,passive aggressive, complaining, autistic fantasy, schizoid,withdrawal and somatization were all significantly higher（ t = 2. 157 -3. 503 ,P=0. 003 -0. 042） ;The total score of the middle defense mechanism was significantly higher [ （4.91 ±0.86） vs. （4.10 ±0.75） ,t =2. 242,P =0.038] ,the scores of reaction formation,removal,avoidance,pseudo- altruism,isolation, denial, association tendency, expectations were significantly higher （ t = 2. 125 - 4. 465, P = 0. 001 - 0. 048 ） ; The total score of the mature mechanism was significantly lower[ （4.89 ± 1.30） vs. （6.04 ± 1.29 ）, t = 2. 142, P =0. 046 ], the scores of suppression and humor were significantly lower, when compared with the control group（ t = - 8. 946, - 6. 535, each P 〈 0. 001 ）. ②Compared with control group, the total score of SSRS in the schizophrenia group was significantly lower[ 35.19 ± 5.27 vs. 42.34 ± 8.38,t = - 5. 238,P = 0. 001 ] ,the scores of the objective, subjective support score, and the utilization of support were significantly lower（ t = - 7. 034 - 2. 864 ,P = 0. 000 - 0. 004 ）. ③The to- tal sore of FAD was significantly higher[ 2.23 ± 0.09 vs. 1.89 ± 0.10, t = 7. 642, P 〈 0. 001 ], the sores of function, prob- lem solving,commutation,role,affective reaction and behavior control score of the FAD were all significantly higher（ t = 5. 261 -8. 033, each P 〈 0. 001 ）. Conclusion The first-episode schizophrenia patients in rehabilitation period show an immature tendency of psychological defense mechanism, with poorer social support and defected family functioning.