短程认知行为治疗联合常规治疗对社区精神分裂症患者疗效的初步观察  

A pilot study on the effect of brief cognitive behavioral therapy combined with routine treatment for schizophrenia in communities of Beijing

作　　者：郭志华[1] 李占江[1] 马云[1] 周裕玲 晁为铭[1] 郭俊花[1] 杨晓婕[1] 

机构地区：[1]首都医科大学附属北京安定医院/临床心理学系精神疾病诊断与治疗北京市重点实验室,100088

出　　处：《中华精神科杂志》2015年第6期331-338,共8页Chinese Journal of Psychiatry

基　　金：首都医学发展科研基金项目（2009-1050）;中国与世界卫生组织2010-2011年度卫生技术合作项目（WPCHN1003566）

摘　　要：目的初步验证操作程式指导下的短程认知行为治疗（brief cognitive behavioral therapv，BCBT）联合常规治疗对社区精神分裂症患者的疗效。方法纳入符合ICD-10精神分裂症诊断标准的社区患者64例，利用计算机生成随机数字分为常规治疗组（n=32）和BCBT联合常规治疗组（n=32）。采用PANSS、个人和社会功能量表（Personal and Social Performance Scale，PSP）和自知力评定量表（schedule for Assessing Insight，SAI）于基线和第12、38、64周末分别对2组患者进行评估。根据疗效评定标准计算有效率和复发率，采用卡方检验比较率的差异。结果（1）与基线比较，BCBT联合常规治疗组第12、38、64周末PANSS总分（均P=0．000）、阳性症状分（均P=0．000）、阴性症状分（P=0．049、0．045、0．024）、精神病理分（均P=0．000）持续下降，差异有统计学意义；常规治疗组第38、64周末的PANSS总分（P=0．001、0．004）和精神病理分（P=0．003、0．001）以及第38周末的阳性症状分（P=0．002）下降，差异有统计学意义。BCBT联合常规治疗组第12、38、64周末的PANSS总分[（53．9±10．9）、（51．0±11．1）、（48．1±11．9）分】和阴性症状分[（12．1±4．3）、（12．1±4．3）、（11．2±4．4）分]低于常规治疗组[（59．4±13．2）、（57．3±11．9）、（57．6±12．9）分，（14.3±5．2）、（14．4±5．1）、（14．3±5．1）分]，差异有统计学意义（F=3．875、4．747、9．943，P=0．042、0．033、0．002；F=7．989、8．814、14．355，P=0．006、0．004、0．000）。BCBT联合常规治疗组第64周末阳性症状分和精神病理分低于常规治疗组[（10．8±3．8）分与（12．8±4．3）分，（25．6±5．3）分与（28．7±6．8）分1，差异有统计学意义（F=5．223，P=0．040；F=4．229，P=0．044）。（2）治疗后BCBT联合常规治疗组的SAI总分持续升高，差异有统计学意义（P=0Objective To evaluate the efficacy of brief cognitive behavioral therapy （BCBT） combined with routine treatment （RT） for patients with schizophrenia in communities of Beijing. Methods 64 patients who met the criteria for schizophrenia according to the International Statistical Classification of Diseases and Related Health Problem, Tenth Revision （ICD-10） were randomly allocated to two groups, one group received 8 sessions of BCBT combined RT and the other group received only RT. All the subjects were evaluated using the Positive and Negative Syndrome Scale （PANSS）, Schedule for Assessing Insight （SAI） and Personal and Social Performance Scale （PSP） at baseline, weeks 12, 38 and 64. The effective and recurrence rates were also calculated and compared between the two groups. Results （1） Compared with the baseline, the scores of PANSS total （all P=0.000）, PANSS-positive （all P=0.000）, PANSS-negative （P= 0.049,0.045,0.024） and PANSS-general （all P=0.000）in BCBT group decreased significantly at weeks 12, 38 and 64. The scores of PANSS total （P=0.001,0.004）and PANSS-general （P=0.003,0.001）in RT group decreased significantly at 38 and 64 week and the score of PANSS-positive （P=0.002） in RT group decreased significantly at 38 week compared with the baseline. The scores of PANSS total （53.9± 10.9, 51.0± 11.1, 48.1 ± 11.9）and PANSS-negative （12.1 ±4.3, 12.1 ±4.3, 11.2±4.4） in BCBT group were significantly lower than that in RT group （59.4±13.2, 57.3±11.9, 57.6±12.9;14.3±5.2, 14.4±5.1, 14.3±5.1） at 12,38 and 64 week （F=3.875,4.747,9.943; P=0.042,0.033,0.002; F=7.989,8.814, 14.355; P=0.006, 0.004,0.000） and the scores of PANSS-positive and PANSS-general were significantly lower than that in RT group （10.8± 3.8 vs. 12.8±4.3; 25.6±5.3 vs. 28.7±6.8） at 64 week （F=5.223, P=0.040; F=4.229, P=0.044）.（2） After treatment, the score of SAI in BCBT group increased significantly （P=0.000,0.001,0.000）and there was no change of SAI in

关 键 词：精神分裂症 认知疗法 药物疗法 社区精神卫生服务 

分 类 号：R749.3[医药卫生—神经病学与精神病学]