精神分裂症儿童长程治疗中病情恢复特点及其影响因素分析  

Characteristics and Influencing Factors of Long-term Recovery in Children with Schizophrenia:A Prospective Follow-up Study

作　　者：张盛夏 罗亮 罗振娟 ZHANG Shengxia;LUO Liang;LUO Zhenjuan(Psychosomatic Department,Xijing Hospital,Xi’an 710032,Shannxi Province,China)

机构地区：[1]空军军医大学西京医院心身科,陕西西安710032

出　　处：《解放军护理杂志》2018年第21期6-10,共5页Nursing Journal of Chinese People's Liberation Army

摘　　要：目的探讨精神分裂症(schizophrenia,SP)儿童长程治疗中病情恢复特点及其影响因素。方法选取2012年5月至2013年3月某院心身科收治的83例儿童SP患者为研究对象,进行为期5年的门诊复查随访,采用阳性与阴性症状量表(positive and negative syndrome scale,PANSS)、个人和社会功能量表(personal social performance scale,PSP)、儿童期逆境问卷(adverse childhood experience scale,ACEs)对患儿进行测定评估。结果 83例患儿有效随访67例(80.7%)。患儿服药依从性为47.8%(32/67)。在治疗后3个月,患儿阳性因子得分显著下降(P<0.05),随访5年均处于稳定水平;阴性因子在第4年开始逐渐恶化,得分逐渐升高。焦虑抑郁因子在治疗后2年内呈下降趋势,但第3年、第4年出现恶化(P<0.05),第5年时恢复至基线水平。治疗初期患儿兴奋敌对因子得分即显著下降(P<0.05),随访过程中只出现小幅度波动。认知损害在治疗前3年明显好转,在第4年、第5年出现恶化,与基线水平无明显差异(P>0.05)。患儿PSP得分稳步升高,社会功能逐渐改善。基线社会适应能力、服药依从性、早期阳性症状缓解、儿童逆境是影响患儿个人和社会功能得分的独立性危险因素。结论SP患儿服药依从性尚可,复发再入院率比例较高。医护人员应重点关注出院后患儿服药依从性,加强对基线社会适应能力较低患儿及高儿童逆境患儿的关注,提高症状缓解率,以改善患儿社会适应能力。Objective To observe the characteristics of illness recovery in children with schizophrenia(SP),and to analyze the factors influencing the recovery of social function.Methods A total of 83 children with SP who were admitted to our hospital from May 2012 to March 2013 were selected as study subjects.Follow-up visits were conducted in next five years.The positive and negative syndrome scale,the personal social performance scale(PSP)and the adverse childhood experience scale were used.Results Totally 67 cases(80.7%)were followed up successfully.The compliance at the final follow-up was 47.8%(32/67).The score of positive factors in children decreased significantly in 3 months after treatment(P<0.05),and then was at a stable level in 5 years.Negative factors began to deteriorate in fourth years,and the scores gradually increased.Anxiety and depression factors showed a downward trend within 2 years after treatment,but worsened in third and fourth years and returned to baseline in fifth years(P<0.05).At the initial stage of treatment,the scores of excitatory hostility factor decreased significantly,and only a slight fluctuation occurred during follow-up(P<0.05).Cognitive impairment improved significantly in the first 3 years before treatment,and worsened in fourth or fifth years,and there was no significant difference compared to baseline(P>0.05).PSP scores of children increased steadily with the extension of treatment time.Multiple linear regression analysis showed that baseline social adaptability,medication adherence,early positive symptoms relief,and children’s adversity were independent risk factors affecting children’s PSP scores.Conclusions The compliance of children with SP was acceptable,and the rate of relapse and hospital re-admission was high.Health care workers should pay more attention to the medication compliance of discharged children,strengthen the attention of children with low baseline social adaptability and children with adversity,in order to improve the social adaptability of children.

关 键 词：精神分裂症 儿童 社会功能 随访 影响因素 

分 类 号：R473.74[医药卫生—护理学]