摘要
目的:分析复发住院精神分裂症患者经过常规药物治疗及药物合并心理社会干预后对药物依从的影响,探讨药物依从性预测指标。方法:纳入150例复发入院精神分裂症患者,其中常规药物治疗组80例,药物合并心理社会干预组70例,收集人口学及临床资料,并于基线及随访治疗3个月时采用阳性与阴性症状量表(PANSS)、个人与社会功能量表(PSP)、用药态度量表(DAI)、自知力问卷(SAI)分别评估患者精神症状、社会功能、服药态度及自知力。随访1年内未服用抗精神病药的时间没有超过1周定义为药物依从。结果:药物合并心理社会干预治疗组依从性高于常规药物治疗组(χ~2=20.56,P<0.001);在随访治疗3个月时药物合并心理社会干预治疗组患者DAI、SAI评分高于常规药物治疗组(P均<0.05);Logistic回归分析显示常规药物治疗组药物依从与否与基线SAI评分(β=0.225,P=0.19)及随访治疗3个月后DTI评分(β=0.302,P=0.4)相关联,药物合并心理社会干预组药物依从与否与基线SAI评分(β=0.264,P=0.027)相关联,与随访3个月时PSP冲动攻击行为得分(β=-1.031,P=0.027)相关联。结论:药物合并心理社会干预药物依从性更佳,良好的自知力及治疗早期较好的服药态度是常规药物治疗依从良好的预测指标,住院时良好的自知力、治疗早期较少的冲动攻击行为是药物合并心理社会干预药物依从良好的预测指标。
Objective： To analyze the influences of conventional medication therapy with or without psychological and social intervention on medicine compliance in patients with recurrent schizophrenia,and to explore the predictors of medication adherence. Method： 150 patients with recurrent schizophrenia were enrolled. Among them,80 patients were treated with conventional medicine only,while the rest 70 patients were treated with conventional medicine combined with psychosocial interventions. Both demographic and clinical data were collected. Positive and Negative Syndrome Scale（ PANSS）,Personal and Social Performance scale（ PSP）,Drug Attitude Inventory（ DAI）,Self-Awareness Inventory（ SAI） were used to assess the psychiatric symptoms,social function,drug attitude and insight of schizophrenic patients at baseline and followed up for three months. More than one week without antipsychotic medication during the following-up year was defined as medication nonadherence and vice versa. Results： Medication adherence rate in psychosocial intervention group was higher than that of the medication-only group（ χ~2= 20. 56,P 0. 001）. Both DAI and SAI scores of patients from psychological intervention group were higher than those of medication-only group after three months of following-up treatment（ all P 0. 05）. Logistic regression analysis showed that medication adherence in conventional medication treatment group was associated with baseline SAI score（ β = 0. 225,P = 0. 019） and DTI score（ β = 0. 302,P = 0. 04） after three months of following-up treatment. Medication adherence in psychosocial intervention group was correlated with baseline SAI scores（ β = 0. 264,P = 0. 027）,and PSP impulsive aggressive behavior scores（ β =-1. 031,P =0. 027） after three months of following-up treatment. Conclusion： The combination of medication and psychosocial intervention could significantly improve medication adherence of recurrent schizophrenic inpatients. Both good insight and positive drug attitude are predictors of medication adherence after conventional medication treatment.Good insight in hospital stay and less impulsive aggression after treatment are predictors of medicine compliance after conventional medicine treatment combined with psychological and social intervention.
作者
佘生林
翁穗芸
许燕
张蓓
宁玉萍
郑英君
SHE Sheng-lin;WEN Sui-yun;XU Yan;ZHANG Bei;NING Yu-ping;ZHENG Ying-jun(The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou 510370, China)
出处
《临床精神医学杂志》
2018年第2期84-87,共4页
Journal of Clinical Psychiatry
基金
国家自然科学基金(81671334)
广州市科技计划项目(2014Y2-00105)
