认知行为治疗改善精神分裂症患者生活质量的随机单盲对照试验

摘要

目的:探讨认知行为治疗对精神分裂症患者生活质量的效果及相关因素,为寻找有效改善精神分裂症患者生活质量的方法提供依据.方法:本研究为单盲随机对照临床试验.选取符合美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)中精神分裂症诊断标准的医院门诊和住院患者共120例,随机分配到认知行为治疗组(CBT组,n=60)和支持性心理治疗组(ST组,n=60),在药物治疗基础上分别接受15次认知行为治疗和支持性心理治疗.在基线采用世界卫生组织生存质量量表简表(WHOQOL-BREF)、阳性和阴性症状量表(PANSS)、应付方式问卷(CSQ)、非理性信念量表(IBS)及自编药物副反应问卷对两组患者进行盲法评定.第12周、24周采用WHOQOL-BREF和自编药物副反应问卷对患者进行随访评估.结果:第12周,CBT组患者WHOQOL-BREF总分各因子分均高于基线[(77.0±13.9) vs.(73.1±13.8),(22.4±4.5)vs.(21.5±4.7),(18.9±4.1)vs.(17.8±4.3),(9.3±2.2)vs.(8.9±2.3),(26.4±5.0) vs.(24.7±5.3),均P＜0.05],而ST组患者仅环境因子有显著改善[(23.9±4.7)vs.(25.0±5.2),P＜0.05],其余因子差异无统计学意义(P＞0.05).第24周,两组在WHOQOL-BREF的社会关系和环境因子分上组间效应显著(F =6.77,7.21,均P＜0.05),CBT组得分均高于ST组.Logistic回归分析发现,基线应对方式分数较低、接受CBT及男性对患者的生活质量有正性预测作用(B=-0.25,2.31,-1.64,均P＜0.05).结论:认知行为治疗能够有效改善精神分裂症患者的生活质量,且基线应对方式得分相对更低、能接受认知行为治疗及男性患者更容易从治疗中获得生活质量的改善.%Objective: To explore the efficacy of cognitive behavioral therapy (CBT) on quality of life in pa-tients with schizophrenia, and so as to find the effective method for improving the quality of life of schizophrenic patients. Methods: In this single blind, randomized controlled study, 120 patients met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for schizophrenia were randomly assigned to CBT group (n =60), and supportive psychotherapy (ST) group (n =60). The patients accepted 15 sessions of CBT or ST respectively. The World Health Organization Quality of Life (WHOQOL-BREF), Positive and Negative Symptoms Scale (PANSS), Irrational Beliefs Scale (IBS), Coping Strategy Questionnaire (CSQ) and the medicine side effects questionnaire were used to assess the efficacy and side effects at baseline, weeks 12 and 24 blindly. Results: In CBT group, the total score and all four fields scores of WHOQOL-BREF were higher at weeks 12 than that at baseline [(77.0 ±13. 9) vs. (73. 1 ± 13. 8), (22. 4 ±4. 5) vs. (21.5 ±4. 7), (18. 9 ±4. 1) vs. (17.8 ±4. 3), (9. 3 ±2.2) vs. (8. 9 ±2. 3), (26.4 ±5.0) vs. (24.7 ±5. 3), Ps <0. 05]. Only environment factor had a significant improvement in ST group [(23. 9 ±4. 7) vs. (25. 0 ±5. 2), Ps <0. 05], the difference in other factors had no statistical significance (P > 0. 05). At the end of follow up, psychological factor and environment factor had a significant group effect (F = 6. 77, 7. 21; P <0. 05). The logistic regression analysis showed that male patients, ones who being willing to accept psychological treatment and ones with lower baseline coping style scores had a positive effect on the quality of life (B= -0. 25,2. 31, - 1. 64; P <0. 05). Conclusion: It suggests that cognitive behavioral therapy could improve the quality of life in patients with schizophrenia, especially in male patients, ones who is willing to accept CBT, and ones who have baseline lower coping style scores.