目的 探索主动式社区家庭治疗对改善精神分裂症患者家庭环境及依从性的影响。方法 2014年1月至2015年9月出院精神分裂症患者122例及其家庭,抽签法分为干预组和对照组各61例。干预组借鉴主动式社区治疗模式,组成专业团队进行家庭治疗等综合干预,对照组接受定期随访,为期1年。入组前、入组6个月及12个月后,用阳性和阴性症状量表(PANSS)、自知力与治疗态度问卷(ITAQ)、家庭环境量表中文版(FES-CV)、药物治疗持续时间、复发率等评估干预效果。结果 入组6个月及12个月后,干预组PANSS总分、ITAQ、FES-CV评分均优于对照组(F组间>1.760, P<0.05);对照组在观察期内复发16例,干预组复发7例(χ2=4.340, P=0.037)。药物治疗持续时间Kaplan-Meier生存分析存在统计学差异(χ2=6.338, P=0.012)。结论 主动式社区家庭治疗能提高精神分裂症患者家庭成员间亲密度,减少高情感表达,提高服药依从性,减少复发。
Objective To explore the effects of assertive community and family treatment on family environment and compliance of patients with schizophrenia. Methods A total of 122 patients with schizophrenia discharged from January, 2014 to September, 2015 along with their families were enrolled and divided into intervention group (n=61) and control group (n=61). The intervention group received comprehensive intervention including family treatment by a professional team in the assertive community treatment model, while the control group received routine follow-up, for twelve months. They were evaluated with Positive and Negative Symptoms Scale (PANSS), Insight and Treatment Attitude Questionnaire (ITAQ), Family Environment Scale-Chinese Version (FES-CV), duration of pharmaceutical treatment and relapse rate before, and six and twelve months after intervention. Results There were statistically significant differences between the intervention group and the control group in total score of PANSS, score of ITAQ and FES-CV six and twelve months after intervention (FGroup>1.760, P<0.05); 16 patients in the control group and seven patients in the intervention group relapsed during the observation period (χ2=4.340, P=0.037). Kaplan-Meier survival analysis showed statistically significant difference between the two groups in duration of pharmaceutical treatment (χ2=6.338, P=0.012). Conclusion Assertive community and family treatment can improve intimacy between patients with schizophrenia and their family members, reduce high emotional expression, improve medication compliance, and reduce relapse.
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