CAJ | 학술논문

目的评价帕利哌酮缓释片联合心理干预对首发精神分裂症门诊治疗患者的临床疗效及社会功能恢复的疗效.方法对符合DSM-Ⅳ诊断标准的62例首发精神分裂症患者进行为期12个月的研究.患者随机分为两组,对照组接受帕利哌酮常规治疗;试验组在常规治疗的基础上给予每月1次心理干预.采用阳性与阴性症状量表(PANSS)个人和社会功能量表(PSP)分别在基线和治疗后第1,3,6,9,12月末评定其疗效及社会功能;于治疗9个月后评定临床痊愈等情况.安全性采用Barnes静坐不能量表(BARS)、锥体外系副反应量表(SAS)及不自主运动量表(AIMS)等评定.结果心理干预联合药物治疗组共27例,单用药物治疗对照组共17例完成试验,脱落率分别为12.9%、45.2%,组间差异具有显著性(P＜0.05).两治疗组治疗后PANSS及PSP总分相对治疗前均有显著改善(P＜0.05),其中心理干预组PANSS减分率＞30%、PSP评分提高≥7、达到临床痊愈标准的患者比例为74.2%、51.6%、67.7%,优于单用药物治疗组的45.2%、38.7%、38.7%(P＜0.05).两治疗组不良事件发生率及类型相似,主要不良反应为锥体外系、心动过速、肠胃道反应、等静坐不能等.结论帕利哌酮缓释片联合心理干预能提高首发精神分裂症门诊患者的治疗依从性.降低治疗中断率,提高临床痊愈患者比例并促进患者社会功能的康复.
목적 평개파리고동완석편연합심리간예대수발정신분렬증문진치료환자적림상료효급사회공능회복적료효.방법 대부합DSM-Ⅳ진단표준적62례수발정신분렬증환자진행위기12개월적연구.환자수궤분위량조,대조조접수파리고동상규치료;시험조재상규치료적기출상급여매월1차심리간예.채용양성여음성증상량표(PANSS)개인화사회공능량표(PSP)분별재기선화치료후제1,3,6,9,12월말평정기료효급사회공능;우치료9개월후평정림상전유등정황.안전성채용Barnes정좌불능량표(BARS)、추체외계부반응량표(SAS)급불자주운동량표(AIMS)등평정.결과 심리간예연합약물치료조공27례,단용약물치료대조조공17례완성시험,탈락솔분별위12.9%、45.2%,조간차이구유현저성(P＜0.05).량치료조치료후PANSS급PSP총분상대치료전균유현저개선(P＜0.05),기중심리간예조PANSS감분솔＞30%、PSP평분제고≥7、체도림상전유표준적환자비례위74.2%、51.6%、67.7%,우우단용약물치료조적45.2%、38.7%、38.7%(P＜0.05).량치료조불량사건발생솔급류형상사,주요불량반응위추체외계、심동과속、장위도반응、등정좌불능등.결론 파리고동완석편연합심리간예능제고수발정신분렬증문진환자적치료의종성.강저치료중단솔,제고림상전유환자비례병촉진환자사회공능적강복.
Objective To evaluate the effect of combination treatment by psychological intervention and a new atypical antipsychotic Paliperidone extended-release tablets(paliperidone ER)on first-episode schizophrenic out-patients.Methods All 62 patients diagnosed as first-episode schizophrenia by DSM-Ⅳ were randomly allocated into,combination treatment group and control group,for a 12-month treatment study.The combination treatment group was treated by paliperidone ER once a day and psychological counseling once a month,while the control group was treated only by paliperidone ER.The efficacy and social function were assessed by Positive and Negative Syndrome Scale(PANSS)and Personal and Social Performance Scale(PSP)individually at baseline,and following 1,3,6,9,12 months.The remission rate was calculated at the end of the 3rd,6th,9th month.The safety and tolerability were assessed using Barnes Akathisia Scale(BARS),extrapyramidal side effects scale(SAS)and involuntary movement scale(AIMS).Results Twenty-seven patients of combination treatment group and seventeen patients of the control group completed the trial with the discontinuation rate 12.9% and 45.2%,respectively.The difference between the above two groups was statistically significant(P＜0.05).The mean total score of PANSS and the PSP of the both groups were significantly improved(P＜0.05)after treatment.PANSS total score reduced more than 30% compared with baseline,and PSP total score increased more than 7.The remission rate of combination treatment group was 74.2%,51.6% and 67.7% at the end of 3rd,6th,and 9th month,which was better than the control group(45.2%,38.7% and 38.7%)(P＜0.05).Both incidence and types of adverse events were almost same between the two groups.The major adverse events were extrapyramidal symptoms,tachycardia,gastrointestinal discomfort and akathisia.Conclusion Paliperidone ER treatment combined with psychological intervention on first-episode schizophrenia out-patients can improve their treatment compliance by reducing the discontinuation rate.And this combination treatment can increase the remission rate and improve social functioning of the patients.