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对内观疗法辅助治疗精神分裂症疗效的1年随访:一项单盲、随机对照研究(英文) 被引量:5

Single-blind, randomized controlled trial of effectiveness of Naikan therapy as an adjunctive treatment for schizophrenia over a one-year follow-up period
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摘要 背景:目前的精神分裂症治疗常常只是部分有效。目的:评估在精神分裂症的治疗中使用辅助性内观疗法可能带来的益处,该疗法是一种源于日本、基于内省的认知方法。方法:在急性精神病性症状缓解后,235例具有初中以上学历的精神分裂症住院患者被随机分为对照组(n=112)或干预组(n=123)。前者接受常规药物治疗和住院康复治疗,后者在此基础上接受辅助性内观疗法,每天2小时,每周5天,为期4周。对所有患者在出院后进行12个月的随访。在基线、干预1个月后以及随访12个月后,采用阳性和阴性症状量表(Positive and Negative Syndrome Scale,PANSS)、个人和社会功能量表(Personal and Social Performance scale,PSP)以及自知力与治疗态度问卷(Insight and Attitude Questionnaire,ITAQ)分别对患者进行评估。对评估者使用盲法,隐瞒患者的分组情况。结果:在12个月的随访中干预组只有13例(10.6%)复发,但是对照组有23例(20.5%)复发(X2=4.50,p=0.034)。使用修正的意向治疗分析和重复测量方差分析,内观疗法组的PANSS、PSP和ITAQ总分均在12个月的随访中比对照组有更显著的改善。尽管两组之间药物剂量(氯丙嗪等效剂量)随时间变化趋势的差异并无统计学意义,但从入组到随访终点,干预组的平均剂量显著减少而对照组的减少在统计学上并不显著。结论:本研究有力支持了内观疗法作为辅助治疗在精神分裂症康复期是有效的。相比于常规治疗,辅以内观疗法可以维持急性治疗期间所取得的精神病性症状改善的疗效、提高对疾病的自知力、提高社会功能,并在一年的随访期内减少复发。这值得我们在更大、更多样化的精神分裂症患者样本中进一步研究这种治疗方法。 Background: Current treatments for schizophrenia are often only partially effective.Aim: Assess the possible benefit of using adjunctive Naikan therapy, a cognitive approach based on selfreflection that originated in Japan for the treatment of schizophrenia.Methods: After resolution of acute psychotic symptoms, 235 psychiatric inpatients with schizophrenia who had a middle school education or higher were randomly assigned to a control group(n=112) that received routine medication and inpatient rehabilitative treatment or an intervention group(n=123) that also received adjunctive Naikan therapy for 2 hours daily, 5 days a week for 4 weeks. The patients were then discharged and followed up for 12 months. The Positive and Negative Syndrome Scale(PANSS), Personal and Social Performance scale(PSP), and Insight and Attitude Questionnaire(ITAQ) were used to assess patients at enrollment, after the 1-month intervention, and after the 12-month follow-up. Evaluators were blind to the group assignment of patients. Results: Only 13(10.6%) of the intervention group participants relapsed over the 12-month follow-up, but 23(20.5%) control group participants relapsed(X2=4.50, p=0.034). Using a modified intention-to-treat analysis and a repeated measure analysis of variance, the PANSS, PSP, and ITAQ total scores all showed significantly greater improvement over the 12-month follow-up in the Naikan group than in the control group. The drop in mean chlorpromazine-equivalent dosage from enrollment to the end of follow-up was significantly different in the intervention group but not in the control group, though the change in dosage over time between groups was not statistically significant. Conclusions: This study provides robust support for the effectiveness of Naikan therapy as an adjunctive treatment during the recovery period of schizophrenia. Compared to treatment as usually, adjunctive Naikan therapy can sustain the improvement in psychotic symptoms achieved during acute treatment, impr
出处 《上海精神医学》 CSCD 2015年第4期220-227,共8页 Shanghai Archives of Psychiatry
关键词 内观疗法 精神分裂症 复发 社会功能 随机对照试验 中国 Naikan therapy schizophrenia relapse social functioning randomized controlled trial China
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