精神分裂症伴强迫思维与行为的暴力风险比较

doi:10.3969/j.issn.1004-583X.2023.03.011

摘要/Abstract

摘要：

目的比较精神分裂症患者伴强迫思维与伴强迫行为的暴力风险与治疗。方法门诊收集46例伴强迫思维的精神分裂症患者和46例伴强迫行为的精神分裂症患者,对其进行暴力风险评定;患者用抗精神病药联合抗强迫药治疗12周,在治疗前及治疗第4、8、12周末,采用阳性与阴性症状量表(PANSS)评定精神症状、耶鲁-布朗强迫量表(Y-BOCS)评定强迫症状、改进版外显攻击行为量表(MOAS)评定暴力风险。结果 Logistic回归分析显示,伴强迫思维、精神病性症状不稳定、男性是暴力风险高的危险因素( $O R$ =13.811, $P$ =0.001; $O R$ =34.183, $P$ =0.002; $O R$ =4.644, $P$ =0.034)。治疗12周后,两组组内各时间点PANSS、Y-BOCS、MOAS总分随时间延长均呈下降趋势( $P$ <0.05)。两组间比较,PANSS总分差异无统计学意义( $F$ =1.52, $P$ =0.221),Y-BOCS、MOAS总分差异有统计学意义( $F$ =7.179, $P$ =0.009; $F$ =6.067, $P$ =0.016)。两组PANSS、Y-BOCS、MOAS总分存在时间主效应( $P$ 均<0.001)和交互效应( $P$ <0.05)。伴强迫思维组Y-BOCS、MOAS总分减少较伴强迫行为组明显。两组8、12周末比较,伴强迫行为组Y-BOCS总分高( $P$ <0.01);两组治疗前、4周末比较,伴强迫思维组MOAS总分高( $P$ <0.01)。结论伴强迫思维的精神分裂症患者的暴力风险明显高于伴强迫行为者;抗精神病药联合抗强迫药治疗能降低伴强迫症状的精神分裂症患者的暴力风险。

关键词: 精神分裂症, 强迫思维, 强迫行为, 暴力风险

Abstract:

Objective To compare the violent risk and clinical treatment of schizophrenia with obsessive-compulsive thinking versusobsessive-compulsive behavior. Methods A total of 46 outpatients with schizophrenia and obsessive-compulsive thinking and 46 outpatients with schizophrenia and obsessive-compulsive behavior were recruited. They were all treated with antipsychotics and anti-compulsions drugs for 12 weeks. Before the treatment, and at 4, 8 and 12 weeks of treatment, patients were assessed using the the Positive and Negative Symptoms Scale (PANSS) for mental symptoms, the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS)for obsessive-compulsive symptoms, and the modified explicit aggressive behavior scale (MOAS) for the violent risk.Results Logistic regression showed that obsessive-compulsive thinking ( $O R$ =13.811, $P$ =0.001), unstable psychotic symptoms ( $O R$ =34.183, $P$ =0.002) and male sex ( $O R$ =4.644, $P$ =0.034) were the risk factors for violence in schizophrenia patients with obsessive-compulsive thinking and behavior. After 12 weeks of treatment, the total scores of PANSS, Y-BOCS, and MOAS at each time point in both groups were gradually reduced with time ( $P$ <0.05). There were no significant differences in the total PANSS scores between groups ( $F$ =1.52, $P$ =0.221). There were significant differences in the total scores of Y-BOCS ( $F$ =7.179, $P$ =0.009) and MOAS ( $F$ =6.067, $P$ =0.016) between groups. Significant main effect of time ( $P$ <0.001) and interaction effect ( $P$ <0.05) were detected in the total scores of PANSS, Y-BOCS and MOAS between groups. The declines of the total scores of Y-BOCS and MOAS were more pronounced in schizophrenia patients with obsessive-compulsive thinking than those with obsessive-compulsive behavior. At 8 and 12 weeks, the total scores of Y-BOCS were significantly higher in schizophrenia patients with obsessive-compulsive behavior than those with obsessive-compulsive thinking ( $P$ <0.01). Before the treatment and at 4 weeks of treatment, the total scores of MOAS were significantly higher in schizophrenia patients with obsessive-compulsive thinking than those with obsessive-compulsive behavior ( $P$ <0.01). Conclusion The violent risk is significantly higher in schizophrenia with obsessive-compulsive thinking than schizophrenia with obsessive-compulsive behavior. Antipsychotics combined with anti-compulsive drugs can reduce the violent risk in schizophrenic patients with obsessive-compulsive symptoms.

Key words: schizophrenia, obsessive thinking, compulsive behaviors, violent risk

中图分类号:

R749.3

林晓东, 曲军民, 于君, 李金明. 精神分裂症伴强迫思维与行为的暴力风险比较[J]. 临床荟萃, 2023, 38(3): 255-259.

Lin Xiaodong, Qu Junmin, Yu Jun, Li Jinming. Risk of violence in schizophrenia patients with obsessive-compulsive thinking versus behaviors: A comparative study[J]. Clinical Focus, 2023, 38(3): 255-259.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.03.011

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I3/255

图/表 5

表1 两组患者基线资料比较( x -±s)

Tab.1 Comparison of baseline data between groups

组别	例数	男 (例)	女 (例)	年龄 (岁)	病程 (年)	体质量 (kg)
伴强迫思维组	46	28	18	36.93±9.16	16.54±7.72	69.13±13.34
伴强迫行为组	46	26	20	35.17±8.36	13.78±6.29	68.09±12.83
$t$ 值/χ²值		0.179		0.963	1.880	0.382
$P$ 值		0.672		0.338	0.063	0.703

表1 两组患者基线资料比较( x -±s)

Tab.1 Comparison of baseline data between groups

组别	例数	男 (例)	女 (例)	年龄 (岁)	病程 (年)	体质量 (kg)
伴强迫思维组	46	28	18	36.93±9.16	16.54±7.72	69.13±13.34
伴强迫行为组	46	26	20	35.17±8.36	13.78±6.29	68.09±12.83
$t$ 值/χ²值		0.179		0.963	1.880	0.382
$P$ 值		0.672		0.338	0.063	0.703

表2 暴力风险可能影响因素赋值表

Tab.2 Assignment table of Affect factors on the violent risk

变量	赋值说明
强迫症状	0=强迫行为,1=强迫思维
联合用药	0=无,1=有
精神病性症状	0=稳定,1=不稳定
性别	0=女,1=男
年龄(岁)	连续变量
病程(月)	连续变量
暴力风险	0=低,1=高

表3 影响暴力风险的多因素Logistic回归分析

Tab.3 Multivariate Logistic regression analysis of the violent risk

变量	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
变量	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
常数项	-1.037	1.683	0.380	0.538	0.354
强迫症状	2.625	0.756	12.053	0.001	13.811	3.137	60.807
联合用药	0.840	0.876	0.920	0.338	2.317	0.416	12.914
精神病性症状	3.532	1.134	9.703	0.002	34.183	3.704	315.426
性别	1.536	0.723	4.515	0.034	4.644	1.127	19.142
年龄	-0.004	0.069	0.003	0.957	0.996	0.870	1.140
病程	-0.082	0.090	0.831	0.362	0.921	0.773	1.099

表3 影响暴力风险的多因素Logistic回归分析

Tab.3 Multivariate Logistic regression analysis of the violent risk

变量	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
变量	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
常数项	-1.037	1.683	0.380	0.538	0.354
强迫症状	2.625	0.756	12.053	0.001	13.811	3.137	60.807
联合用药	0.840	0.876	0.920	0.338	2.317	0.416	12.914
精神病性症状	3.532	1.134	9.703	0.002	34.183	3.704	315.426
性别	1.536	0.723	4.515	0.034	4.644	1.127	19.142
年龄	-0.004	0.069	0.003	0.957	0.996	0.870	1.140
病程	-0.082	0.090	0.831	0.362	0.921	0.773	1.099

表4 两组治疗前后PANSS、Y-BOCS、MOAS评分比较( x -±s)

Tab.4 Comparison of PANSS, Y-BOCS and MOAS scores before and after treatment between groups

组别	时间	PANSS总分	Y-BOCS总分	MOAS总分
伴强迫思维组	治疗前	85.91±12.54	10.85±2.24	12.98±3.88^*
( $n$ =46)	治疗4周	75.48±12.47	9.83±2.36	10.72±3.64^*
	治疗8周	64.39±12.73	7.72±2.27^*	8.59±3.52
	治疗12周	53.09±12.48	4.67±2.31^*	5.30±2.97
伴强迫行为组	治疗前	83.78±12.91	11.04±2.47	9.39±2.78
( $n$ =46)	治疗4周	71.93±12.84	10.09±2.40	8.41±2.55
	治疗8周	61.13±12.80	9.11±2.38	7.37±2.47
	治疗12周	49.13±12.41	8.07±2.34	6.20±2.32
	组间效应	$F$ =1.52, $P$ =0.221	$F$ =7.179, $P$ =0.009	$F$ =6.067, $P$ =0.016
	时间效应	$F$ =2944.29, $P$ <0.01	$F$ =2137.90, $P$ <0.01	$F$ =651.76, $P$ <0.01
	交互效应	$F$ =3.151, $P$ <0.05	$F$ =471.93, $P$ <0.01	$F$ =99.75, $P$ <0.01

表4 两组治疗前后PANSS、Y-BOCS、MOAS评分比较( x -±s)

Tab.4 Comparison of PANSS, Y-BOCS and MOAS scores before and after treatment between groups

组别	时间	PANSS总分	Y-BOCS总分	MOAS总分
伴强迫思维组	治疗前	85.91±12.54	10.85±2.24	12.98±3.88^*
( $n$ =46)	治疗4周	75.48±12.47	9.83±2.36	10.72±3.64^*
	治疗8周	64.39±12.73	7.72±2.27^*	8.59±3.52
	治疗12周	53.09±12.48	4.67±2.31^*	5.30±2.97
伴强迫行为组	治疗前	83.78±12.91	11.04±2.47	9.39±2.78
( $n$ =46)	治疗4周	71.93±12.84	10.09±2.40	8.41±2.55
	治疗8周	61.13±12.80	9.11±2.38	7.37±2.47
	治疗12周	49.13±12.41	8.07±2.34	6.20±2.32
	组间效应	$F$ =1.52, $P$ =0.221	$F$ =7.179, $P$ =0.009	$F$ =6.067, $P$ =0.016
	时间效应	$F$ =2944.29, $P$ <0.01	$F$ =2137.90, $P$ <0.01	$F$ =651.76, $P$ <0.01
	交互效应	$F$ =3.151, $P$ <0.05	$F$ =471.93, $P$ <0.01	$F$ =99.75, $P$ <0.01

表5 两组不良反应比较( n=46, 例次)

Tab.5 Comparison of adverse reactions between groups( n=46, case-times)

组别	恶心	头晕	失眠	嗜睡	口干便秘	体重增加	锥体外系反应
伴强迫思维组	5	4	4	6	7	9	6
伴强迫行为组	4	5	3	4	8	7	8
χ²值	0.123	0.123	0.155	0.449	0.080	0.303	0.337
$P$ 值	0.726	0.726	0.694	0.503	0.778	0.582	0.562

表5 两组不良反应比较( n=46, 例次)

Tab.5 Comparison of adverse reactions between groups( n=46, case-times)

组别	恶心	头晕	失眠	嗜睡	口干便秘	体重增加	锥体外系反应
伴强迫思维组	5	4	4	6	7	9	6
伴强迫行为组	4	5	3	4	8	7	8
χ²值	0.123	0.123	0.155	0.449	0.080	0.303	0.337
$P$ 值	0.726	0.726	0.694	0.503	0.778	0.582	0.562

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