CCT与MSST联合分阶段干预对青少年精神分裂症病人认知功能的影响

Effects of CCT and MSST combined with staged intervention on cognitive function in adolescent patients with schizophrenia

目的:探讨认知补偿训练(CCT)与药物自我管理技能训练(MSST)联合分阶段干预对青少年精神分裂症病人认知功能的影响。方法:选取青少年精神分裂症病人59例为研究对象,随机分成观察组29例和对照组30例,对照组采取常规治疗干预,观察组采取MSST+CCT联合分阶段干预,比较2组干预前后认知功能、精神症状、服药依从性的变化。结果:观察组认知策略练习依从性较差者7例(24.1%),药物管理依从性较差者7例(24.1%)。病人住院时间与服药总天数呈明显正相关关系(r=0.493,P<0.01),服药总时间与CCT练习测量总时间呈正相关关系(r=0.379,P<0.05),CCT练习策略总次数与练习测量总时间呈正相关关系(r=0.450,P<0.05)。干预前2组阳性与阴性症状量表(PANSS)总分和各分量表得分、认知功能测定(MMSE)总分、服药依从性总分比较差异均无统计学意义(P>0.05)。课程学习结束后,观察组PANSS总分低于对照组(P<0.05),PANSS各分量表得分、MMSE总分、服药依从性总分差异均无统计学意义(P>0.05)。干预后3个月,观察组在PANSS总分和各分量表得分、MMSE总分、服药依从性总分上均优于对照组(P<0.05~P<0.01)。2组在干预前后各时间点各维度比较差异均有统计学意义(P<0.05~P<0.01),观察组在课程结束后、干预3个月的PANSS总分、阳性症状得分上均较干预前降低(P<0.05~P<0.01),对照组在干预3个月的PANSS总分、阳性症状得分上均较干预前和课程结束后有所降低(P<0.01);观察组干预后3个月在阴性症状上均较干预前和课程结束后降低(P<0.01),对照组干预后3个月在阴性症状上均较干预前降低(P<0.01);2组干预后3个月一般精神症状均较干预前和课程结束后降低(P<0.05~P<0.01),MMSE总分均较干预前和课程结束后增加(P<0.01);2组在课程结束后、干预3个月的服药依从性得分均较干预前降低(P<0.01),观察组干预后3个月服药依从性得分较课程结束后仍降低(P<0.01)。且观察组降低和增加幅度均高于对照组(P<0.05~P<0.01)。结论:CCT与MSST联合干预的方式,可以更好地改善青少年精神分裂症的认知功能,精神病症状和用药依从性,值得临床推广应用。

Objective:To explore the effects of compensatory cognitive training(CCT)and medication self-management skills training(MSST)combined with staged intervention on cognitive function in adolescent patients with schizophrenia.Methods:A total of 59 cases of adolescent schizophrenia patients were selected as research objects,who were randomly divided into observation group(n=29)and control group(n=30).The control group took routine treatment intervention,and the observation group took MSST+CCT combined staged intervention.The changes of cognitive function,mental symptoms and medication compliance before and after intervention were compared between the two groups.Results:In the observation group,7 patients(24.1%)had poor compliance with cognitive strategy exercise,and 7 patients(24.1%)had poor compliance with drug management.The length of hospital stay was positively correlated with the total number of days of taking medication(r=0.493,P<0.01).There was a positive correlation between the total number of days of taking medication and the total number of days of CCT practice measurement(r=0.379,P<0.05).The total number of CCT practice strategies was positively correlated with the total number of practice measurement days(r=0.450,P<0.05).Before intervention,there were no significant differences in the total score of positive and negative symptom scale(PANSS),total score of each subscale,total score of min-mental state examination(MMSE),and total score of medication compliance between the two groups(P<0.05).After the course,the total score of PANSS in the observation group was lower than that in the control group(P<0.05),there were no significant differences in PANSS subscales scores,MMSE total scores and medication compliance total scores(P<0.05).Three months after intervention,the total scores of PANSS and its subscales,MMSE and medication compliance in the observation group were better than those in the control group(P<0.05 to P<0.01).There were statistically significant differences between the two groups at each time point before and after intervention(P<0.05 to P<0.01),the PANSS total positive symptom scores of the observation group at 3 months after intervention were lower than those before intervention(P<0.05 to P<0.01),PANSS total positive symptom scores of the control group at 3 months of intervention were lower than those before intervention and after the end of the course(P<0.01);the negative symptoms in the observation group were lower 3 months after intervention than before and after the course(P<0.01),the negative symptoms in the control group were lower than those before intervention 3 months after intervention(P<0.01);general psychiatric symptoms in both groups were lower 3 months after intervention than before and after the course(P<0.05 to P<0.01),MMSE total scores increased compared with those before and after intervention(P<0.01);the scores of medication compliance in both groups at 3 months after intervention were lower than those before intervention(P<0.01),3 months after intervention,the compliance score of the observation group continued to decrease compared with that after the course(P<0.01),and the amplitude of decrease and increase in observation group was higher than that in control group(P<0.05 to P<0.01).Conclusions:The combined intervention of CCT and MSST can better improve the cognitive function,psychotic symptoms and medication compliance of adolescent schizophrenia,which is worthy of clinical application.