家庭干预对首发精神分裂症患者辅助治疗的随访研究

摘要

目的:探讨家庭干预对首发精神分裂症患者预后的影响.方法:将90例首发精神分裂症患者随机分为抗精神病药物合并家庭干预组(干预组,45例)及单用抗精神病药物组(对照组,45例),进行为期1年的随访研究.采用家庭亲密度和适应性量表(FACESⅡ-CV)、家庭功能量表(FAD)、简明精神病评定量表(BPRS)、阳性症状评定量表(SAPS)及阴性症状评定量表(SANS)评估患者家庭状况和精神症状.结果:随访结束后,干预组家庭亲密度和适应性及家庭功能改善明显(P＜0.01)；干预组FACESⅡ-CV中的实际亲密度、理想亲密度因子评分显著高于对照组[(66.7±12.2)分、(57.7±10.4)分、(68.4±10.6)分、(55.8±9.7)分,P均＜0.01],干预组FAD中的沟通、角色、情感反应、情感介入、行为控制及总的功能因子评分显著低于对照组(P均＜0.05)；两组BPRS、SAPS及SANS评分均较人组时有明显下降(P均＜0.01),随访期干预组BPRS和SANS评分显著低于对照组[(19.6±10.7)分、(21.8 ±12.5)分、(16.7±6.4)分、(18.8±7.2)分,P均＜0.01]；多元逐步回归分析显示患者精神症状预后与基线期精神症状严重程度呈正相关,与基线期家庭功能及发病年龄呈负相关(t=2.65,-2.49,-2.79,P均＜0.05).结论:对精神分裂症患者进行家庭干预,可增加患者家庭亲密度和适应性,提高家庭功能,改善疾病预后.%Objective:To investigate the effect of family intervention on the prognosis of first-episode schizophrenic patients. Method:90 first-episode schizophrenic patients were randomly divided into interven- ,, tion group ( receiving family intervention and regular antipsychotics, n = 45 ) and control group ( receiving regu lar antipsychotics only, n = 45 ). Both groups were followed for one year using family adaptability and cohesion scale ( FACES II -CV ) , family assessment device ( FAD ) , brief psychiatric rating scale ( BPRS ) , scale for as/ sessment of positive symptoms ( SAPS) and scale for assessment of negative symptoms ( SANS) to assess the family condition and severity of symptoms. Results: At the end of follow-up,the family adaptability and cohe sion, and function of intervention group were significantly improved (Ps <0. 01) ;the scores of reality and ideal cohesion were higher in intervention group than control group [ (66. 7 ± 12. 2) vs (57.7 ± 10.4) , (68.4 ± 10.0) vs (55. 8 ±9. 7 ) , all P < 0. 01 ] , the scores of negotiation, role, emotional response, emotional involvement, be havioral control and total function were lower in intervention group than control group (all P <0. 05) ;the scores of BPRS,SAPS and SANS in both groups significantly decreased (all P<0.01) ,the scores of BPRS and SANS in intervention group were lower than in control group [ ( 19. 6 ± 10. 7 ) vs (21. 8 ± 12. 5 ) , ( 16. 7 ± 6. 4 ) vs (18. 8 ±7.2) ,all P <0. 01 ] ;Multivariate regression analysis revealed that the prognosis of psychotic symptoms was positively correlated with the severity of psychotic symptom at baseline and negatively correlated with family function at baseline and onset age (t = 2.65, - 2.49, - 2. 79, all P < 0. 05). Conclusion: Family interven tion is helpful to improve the prognosis of schizophrenic patients.