利伯曼精神康復技術對長期住院的慢性精神分裂癥患者的康復作用

陳丁玲,蔡守彬,陳志明,陳梓朗,陳妙揚

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利伯曼精神康復技術對長期住院的慢性精神分裂癥患者的康復作用

陳丁玲,蔡守彬,陳志明,陳梓朗,陳妙揚

目的探討利伯曼精神康復技術對長期住院的慢性精神分裂癥患者精神癥狀及自知力的影響。方法133例長期住院的慢性精神分裂癥患者隨機分為研究組和對照組。研究組在住院條件下接受抗精神病藥物治療及常規護理基礎上,接受每周5次、連續7周的利伯曼精神康復訓練；對照組僅接受常規住院的藥物治療及護理。兩組在訓練前、訓練3個月及6個月時分別進行陽性和陰性癥狀量表(PANSS)及自知力和治療態度問卷(ITAQ)的評定。兩組PANSS及ITAQ比較采用重復測量方差分析。結果在PANSS陽性癥狀分上時間效應顯著(F=22.980,P<0.001)。在PANSS陰性癥狀上組間效應(F=6.932,P=0.009)及時間效應(F=12.485,P<0.001)均顯著。在PANSS一般病理癥狀上時間效應顯著(F=25.786,P<0.001)。ITAQ組間效應(F=4.461,P=0.037)、時間效應(F=56.622,P<0.001)及交互效應(F=6.609,P=0.002)均顯著。結論利伯曼精神康復訓練能更好地幫助長期住院的慢性精神分裂癥患者改善陰性癥狀及提高自知力。

利伯曼精神康復； 長期住院； 精神分裂癥； 自知力

Abstract：Objective： To explore the effects of Lieberman mental rehabilitation technique on symptoms and insight in long-term hospital patients with schizophrenia.Method：one hundred and thirty three long-term hospital patients with schizophrenia were enrolled and were randomly divided into the study group and the control group.The control group only received routine drug treatment and nursing care.The study group received Lieberman rehabilitation training for 7 weeks (5 times every week) and routine drug treatment and nursing care.The positive and negative syndrome scale (PANSS) and insight and treatment attitudes questionnaire (ITAQ) were assessed at baseline,month 3 and 6.Analysis of variance of repeated measures were used to compare the scores of the PANSS and ITAQ between groups.Results：There were significant time main effect on PANSS positive,negative and general domains (P<0.05),and were significant group main effect on PANSS negative domain (P<0.05).There were significant time effect,group effect and time × group interactions on ITAQ (P<0.05).Conclusion： Lieberman rehabilitation training can improve negative symptoms and insight in long-term hospital patients with schizophrenia.

Keywords： Lieberman mental rehabilitation; long-term hospitalization; schizophrenia; insight

精神分裂癥是一類最常見的慢性遷延性、高復發性、高致殘性的精神疾病[1]。由于自知力缺損嚴重、維持治療的依從性差及無法適應激烈的社會競爭等,患者病情反復發作,導致頻繁住院甚至長期住院。住院的精神分裂癥患者,雖然在醫療護理協助下能堅持規律服藥,但大部分患者自知力仍未能有效恢復[2]。精神康復技術可幫助精神分裂癥患者穩定病情、改善自知力及提高服藥依從性。目前報道精神康復方法眾多,但很少適應用于長期住院患者,并且欠缺統一的操作規范及標準的評估方式,難于有效地廣泛應用及推廣。利伯曼精神康復技術[3-5]由美國加州大學洛杉磯分校利伯曼教授創制,是一套以認知行為治療為基礎的技能訓練,具有很強的行為治療性,以小組形式開展,教給康復者解決新出現問題的技巧、社會交往及回歸社會技巧。……