基于评估的治疗模式对精神分裂症患者症状和功能影响的随访研究

doi:10.3969/j.issn.1004-583X.2019.06.009

摘要/Abstract

摘要： 目的探讨基于评估的治疗模式对精神分裂症患者精神症状和社会功能的影响。方法 2017年3月至2018年3月在衡水市精神病医院进行门诊和住院治疗的符合DSMV诊断标准的精神分裂症患者120例，根据随机数字表法分为研究组和对照组各60例。研究组采用基于评估的治疗模式进行干预，即服用第二代抗精神病药物利培酮片最高剂量4~6mg/d，根据入组第2周末的阴性及阳性症状量表（positive and negative syndrome scale，PANSS）评分减分率＜20%替换为奥氮平片治疗，采用交叉换药的方式换药。对照组采用常规治疗方案，即给予利培酮片最高剂量（同研究组），维持剂量不变至研究结束。在治疗前、治疗第2周末、第4周末、第8周末分别评估PANSS及个人和社会功能量表（personal and social performance scale，PSP），观察患者的精神症状和社会功能，并随访半年。结果研究组因肌注氟哌啶醇针剂或合并其他第二代抗精神病药退出共9例，不良反应退出1例，撤回知情同意1例；对照组因肌注氟哌啶醇针剂或合并口服其他第二代抗精神病药退出共7例，不良反应退出3例，撤回知情同意3例。在治疗第4周、8周末，研究组的阳性症状分、PANSS总分低于对照组（P<0.05）。而两组阴性症状分在任何时间点的差异均无统计学意义（P>0.05）；一般精神病理分仅在治疗第8周末组间差异有统计学意义（P<0.05）。在治疗第4周、8周末，研究组的PSP评分明显高于对照组（P<0.05）。随访6个月时，仍是研究组PSP评分较高（P<0.01）。结论基于评估的治疗模式可以早期控制精神分裂症患者的精神症状，并有助于改善社会功能。

关键词: 精神分裂症, 基于评估的治疗, 疗效, 社会功能, 随访

Abstract: Objective To investigate the efficacy and safety of an assessmentbased treatment model in patients with schizophrenia.Methods A total of 120 patients with schizophrenia who met the DSMV diagnostic criteria in our hospital from March 2017 to March 2018 were randomly divided into the study group and the control group, for each group 60 patients.The study group adopted an assessmentbased treatment model to take the secondgeneration antipsychotic risperidone tablets at a maximum dose of 46 mg/day. An assessment was performed at the end of the second week according to the negative and positive scales (PANSS). Should the rate of decreasebe less than 20%, replace it with olanzapine in a crossed way. The control group, however, adopted a conventional treatment plan, that is, administering the maximum dose of risperidone from the very beginning to the end of the study.PANSS and the Personal and Social Performance Scale (PSP) were evaluated before treatment, at the end of the 2nd weekend, the 4th weekend, and the 8th week to observe the patient's mental symptoms and social function, a sixmonth followup was carried out. Results In the study group, 9 cases were withdrawn due to intramuscular injection of haloperidol injection or other secondgeneration antipsychotic drugs, 1 case due to the adverse reactions, and 1 case due to the withdrawal of informed consent. In the control group, a total of 7 cases were withdrawn due to intramuscular injection of haloperidol injection or other the secondgeneration antipsychotic drugs, 3 cases due to adverse reactions, and 3 cases due to the withdrawl of the informed consent. At the end of the 4th and 8th week of treatment, the positive symptom score ［the 4th weekend (15.65±3.23 vs 18.04±2.50), the 8th weekend (13.35±2.90 vs 14.68±2.25)］, and the PANSS total score ［the 4th weekend (69.22±5.29 vs 72.04±5.53), the 8th weekend (58.33±4.44 vs 61.47±5.63)］ of the study group were significantly lower thanthose of the control group, and the difference was statistically significant (P<0.05);There was no significant difference in the negative symptoms between the two groups at any time point (P>0.05). The general psychopathological scores (31.94±2.40 vs 33.36±4.10) were only statistically significant at the 8th week of treatment (P<0.05), and that of the study group was even lower. At the 4th week and the 8th week of treatment, the PSP scores of the study group ［the 4th weekend (52.37±5.40 vs 49.36±4.91), the 8th weekend (61.33±5.81 vs 57.49±5.64)］ were significantly higher than that of the control group, and the differences were statistically significant (P<0.05); the PSP score (70.45±6.23 vs 65.83±5.97) of the study group was significantly higher than the other group during 6 months of followup (P<0.01).Conclusion The assessmentbased treatment models can control mental symptoms in patients with schizophrenia at an early stage and help improve their social function.

Key words: schizophrenia, assessmentbased treatment, efficacy, social function, followup

郗玲燕1，黄秀芹1，张素允1，李紫玉1，徐从恩1，金圭星2. 基于评估的治疗模式对精神分裂症患者症状和功能影响的随访研究[J]. 临床荟萃, doi: 10.3969/j.issn.1004-583X.2019.06.009.

Xi Lingyan1, Huang Xiuqin1, Zhang Suyun1, Li Ziyu1, Xu Congen1, Jin Guixing2. The efficacy and safety of assessmentbased treatment models in patients with schizophrenia[J]. Clinical Focus, doi: 10.3969/j.issn.1004-583X.2019.06.009.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2019.06.009

https://huicui.hebmu.edu.cn/CN/Y2019/V34/I6/530

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基于评估的治疗模式对精神分裂症患者症状和功能影响的随访研究

The efficacy and safety of assessmentbased treatment models in patients with schizophrenia

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