主动式社区治疗模式对社区精神分裂症患者的疗效  

Efficacy of assertive community treatment on community patients with schizophrenia

作　　者：周轶卿 卓恺明 周国权[1] ZHOU Yi-qing;ZHUO Kai-ming;ZHOU Guo-quan(Shanghai Putuo District Mental Health Center,ShangHai 200065,China)

机构地区：[1]上海市普陀区精神卫生中心,200065 [2]上海交通大学医学院附属精神卫生中心

出　　处：《临床精神医学杂志》2023年第1期55-58,共4页Journal of Clinical Psychiatry

基　　金：上海市普陀区卫生健康系统科技创新项目(ptkwws202219,普KW15207)。

摘　　要：目的:探讨社区精神分裂症患者接受主动式社区治疗模式(assertive community treatment,ACT)后临床症状的变化及其相关因素。方法:本研究共纳入200例精神分裂症患者,随机分配为干预组与对照组,开展为期1年的随访干预,使用阳性与阴性症状量表(PANSS)、自尊量表(SES)和精神分裂症患者生活质量量表(SQLS)分别评估其精神症状、社会功能及自我感受。结果:干预前后两组间PANSS总分及分量表评分、SES得分存在时间×组别交互作用,PANSS减分率、PANSS阴性分量表减分率、PANSS一般病理分量表减分率、SES增幅的差异具有统计学意义,SQLS各因子分的变化幅度的组间差异均无统计学意义(P>0.05);干预组PANSS减分率与SES增幅呈正相关(r=0.242,P=0.001);与SQLS量表中的心理社会、动力与精力等因子分减分率呈正相关(r=0.260,P=0.001;r=0.200,P=0.008);Logistic逐步回归分析结果显示,基线SQLS量表症状与副作用因子分是危险因素(OR=1.030,95%CI:1.033~1.058,P<0.05)。结论:主动式社区治疗模式能够有效改善社区患者的精神症状,其疗效与患者自尊体验改善及生活质量密切相关。Objective:To investigate the impact of assertive community treatment(ACT)on community patients with schizophrenia.Method:200 patients with schizophrenia were randomly assigned to the intervention group or the control group.The severity of symptoms,the level of social functioning,and the self-perceived disease burden during a one-year study were assessed with the Positive and Negative Syndrome Scale(PANSS),Socioeconomic Status(SES),and Schizophrenia Quality of Life Scale(SQLS).Results:Repeated-measurement analysis of variance results showed time×group interaction on the PANSS total scale and subscale,and SES scores,decrease rate differences of PANSS total score,PANSS negative score,PANSS general subscore,and the increase difference of SES were significant between the two groups before and after treatment.However,no statistically significant difference was observed when evaluated using the SQLS factor scores(P>0.05).The reduction in the PANSS total score was positively correlated with SES improvement in the intervention group(r=0.242,P=0.001).Similarly there was a positive correlation with the reduction in SQLS factor score including psychosocial(r=0.260,P=0.001)and energy/motivation(r=0.200,P=0.008).Moreover,using multiple Logistic regression analysis,we identified the symptoms/side effects SQLS factor score as a risk factor(OR=1.030,95%CI:1.033-1.058,P<0.05).Conclusion:ACT might be beneficial in improving the symptoms of schizophrenia,which are closely related to higher self-esteem and quality of life.

关 键 词：精神分裂症 主动式社区治疗模式 自尊 生活质量 

分 类 号：R749.3[医药卫生—神经病学与精神病学]