情感气质对强化门诊干预项目中双相障碍患者药物依从性的影响  

The impact of emotional temperament on medication adherence of bipolar disorder patients in Intensive Outpatient Program

作　　者：吴丹萍 卢卫红 孙霞 王勇[1] 薛莉莉 黄佳[1] 吴志国[1] 叶尘宇[3] 王宇 宋蕊 苑成梅[1] WU Danping;LU Weihong;SUN Xia;WANG Yong;XUE Lili;HUANG Jia;WU Zhiguo;YE Chengyu;WANG Yu;SONG Rui;YUAN Chengmei(Shanghai Mental Health Center,Shanghai 200030,China)

机构地区：[1]上海交通大学医学院附属精神卫生中心,上海200030 [2]上海交通大学医学院附属仁济医院 [3]复旦大学附属中山医院 [4]虹口区精神卫生中心

出　　处：《中国神经精神疾病杂志》2018年第6期349-353,共5页Chinese Journal of Nervous and Mental Diseases

基　　金：上海市科委医学引导项目(编号:124119a8602);上海市申康发展中心适宜技术联合开发推广应用项目(编号:SHDC12016205);上海交通大学“医工交叉研究基金”面上项目(编号:YG2011MS37);上海市卫生局公共卫生海外留学人才项目(编号:GWHW201202);科技部"十二五"国家科技支撑项目(编号:2012BAI01B04)。

摘　　要：目的探讨新近缓解的双相障碍患者在参加强化门诊干预项目(intensive outpatient program,IOP)时,情感气质对患者药物依从性的影响。方法纳入近4个月有一次急性发作而目前处于缓解期的双相障碍患者,按本人对治疗的倾向性分为干预组和对照组,干预组在常规药物干预下同时进行为期约4周共10次IOP干预,对照组仅接受常规药物治疗。使用情感气质自评量表简版评价患者情感气质,治疗前后用药物依从性评价量表评估药物依从性水平,并根据治疗结束时依从性分为高依从性(≥6分)和低依从性(<6分)亚组,探讨情感气质对参加IOP双相障碍患者依从性的影响。结果治疗结束时高依从性组45例,低依从性组18例。干预组中高、低依从性亚组未治疗时间、抑郁气质得分差异有统计学意义(P<0.05),其他社会人口学因素组间差异均无统计学意义(P>0.05)。Logistic回归分析显示IOP干预(OR=6.32,95%CI:1.59~25.14)和抑郁气质(OR=0.71,95%CI:0.52~0.96)影响药物依从性(P<0.05),药物依从性预测模型受试者工作特征曲线的曲线下面积为0.85。分层logistic回归分析示抑郁气质在干预中的调节效应无统计学意义(P=0.06)。结论 IOP干预可以改善双相障碍患者药物依从性,而抑郁气质会损害药物依从性。Objective To explore the impact of emotional temperament on medication adherence of bipolar disorder patients who newly reached remission when receiving intensive outpatient program(IOP).Methods Patients in euthymia with at least one acute episode during past 4 months were divided into intervention group and control groups according to their intention to treatment.Intervention group received routine medication and 10 sessions of IOP intervention for about 4 weeks,while controlled group only received routine medication.Emotional temperament was collected from Temperament Evaluation of Memphis,Pisa,Paris and San Diego-Auto Questionnaire(TEMPS-A)pre-treatment,while Medication Adherence Rating Scale(MARS)was used to assess the medication adherence pre-and post-treatment.By dividing post-treatment MARS score into high-adherence(≥6)and low-adherence(<6)as dependent variable,logistic regression analyze was used to explore the impact of temperament.Results There were 45 patients in high-adherence group and 18 in low-adherence group.Demographic variables were not significantly different between high-and low-adherence groups or between intervention and control groups(all P>0.05),except for the duration of untreated psychosis(P=0.04)and dysthmic temperament(P<0.01)in intervention group.The results of logistic regression showed that only IOP intervention(OR=6.32,95%CI:1.59~25.14)and dysthmic temperament(OR=0.71,95%CI:0.52~0.96)influenced medication adherence(P<0.05),and area under curve of ROC analysis of model was 0.85,while hierarchical logistics did not reveal significant moderating effect.Conclusion IOP intervention can improve medication adherence,while dysthymic temperament may impede adherence.

关 键 词：双相障碍 药物依从性 强化门诊干预项目 抑郁气质 

分 类 号：R749.4[医药卫生—神经病学与精神病学]