认知适应训练对精神分裂症患者认知功能及社会功能的影响

李碧霞; 马灵亚; 余小定

doi:10.16766/j.cnki.issn.1674-4152.003341

认知适应训练对精神分裂症患者认知功能及社会功能的影响

doi: 10.16766/j.cnki.issn.1674-4152.003341

1.
绍兴市第七人民医院精六病区，浙江绍兴 312000
2.
绍兴市第七人民医院心身障碍科(睡眠二病区)

基金项目:

浙江省卫生健康科技计划项目 2022ZH062

详细信息

通讯作者:
李碧霞，E-mail：libixia0217@163.com

中图分类号: R749.3 R749.05
计量
- 文章访问数: 205
- HTML全文浏览量: 107
- PDF下载量: 8
- 被引次数: 0
出版历程
- 收稿日期: 2023-10-09
- 网络出版日期: 2024-03-09

Effect of cognitive adaptation training on cognitive function and social function of schizophrenia patients

1.
Shaoxing No.7 People's Hospital Psychiatry Department 6, Shaoxing, Zhejiang 312000, China

摘要

摘要: 目的分析认知适应训练对精神分裂症患者的效果，及对患者认知功能及社会功能等指标的影响。方法采用便利抽样法，选取2019年10月—2023年6月绍兴市第七人民医院收治的166例男性精神分裂症患者，根据随机数字表法将其分为对照组(83例)和观察组(83例)。对照组应用常规护理及康复训练，观察组在对照组基础上应用认知适应训练。比较2组患者干预前后精神症状、认知功能及社会功能，统计2组患者服药依从性。结果干预后，2组患者阳性和阴性症状量表(PANSS)评分均下降，且观察组各维度得分及总分均明显低于对照组(P＜0.05)；干预后，2组患者精神分裂症认知功能成套测验(MCCB)得分均提高，且观察组得分[(55.71±3.82)分]明显高于对照组[(53.21±4.16)分，P＜0.05]；干预后，2组患者功能大体评定量表(GAF)、个人和社会功能量表(PSP)得分均提高，观察组得分分别为(75.43±5.83)分、(63.35±4.63)分，均高于对照组[(68.92±6.90)分、(58.91±5.39)分，P＜0.05]。观察组患者服药依从性高于对照组(P＜0.05)。结论认知适应训练能在常规治疗及护理的基础上减轻精神分裂症患者疾病症状，改善患者认知功能及社会功能，并有效提高患者服药依从性，值得临床应用。
- 精神分裂症 /
- 认知适应训练 /
- 认知功能 /
- 社会功能
Abstract: Objective To analyze the nursing effect of cognitive adaptation training on patients with schizophrenia, as well as its impact on indicators such as cognitive function and social function. Methods Using convenient sampling method, 166 patients with schizophrenia admitted to Shaoxing Seventh People's Hospital from October 2019 to June 2023 were chosen as the research object, and they were randomly split into control group and observation group, with 83 patients in each group. Patients in the control group were given routine nursing and rehabilitation training, while patients in the observation group were given cognitive adaptation training on the basis of the control group. The mental symptoms, cognitive function and social function of the two teams were compared before and after intervention, and the medication compliance of the two groups was counted. Results After the intervention, the positive and negative symptom scale (PANSS) of the two groups decreased, and the scores and total scores of each dimension in the observation group were obviously lower than those in the control group (P < 0.05). After the intervention, the scores of MATRICS consensus cognitive battery (MCCB) of patients in both groups were improved, and the observation group scored (55.71±3.82) points were obviously higher than that in the control groups [(53.21±4.16) points, P < 0.05]. After the intervention, the patients' global assessment of function (GAF) and personal and social performance scale (PSP) in both groups were improved, but the scores of each scale in the observation group were (75.43±5.83) points and (63.35±4.63) points, respectively, which were higher than those in the control groups [(68.92±6.90) points and (58.91±5.39) points, P < 0.05]. The medication compliance of the observation group was higher than that of the control group (P < 0.05). Conclusion Cognitive adaptation training can relieve the symptoms of schizophrenia patients on the basis of routine treatment and nursing, improve their cognitive and social functions, and effectively improve their medication compliance, which is worthy of clinical application.
- Schizophrenia /
- Cognitive adaptation training /
- Cognitive function /
- Social function

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表 1 2组精神分裂症患者一般资料比较(x±s)

Table 1. Comparison of general data of two groups of schizophrenic patients(x±s)

组别	例数	年龄(岁)	受教育年限(年)	病程时间(年)	住院时间(d)	口服药物剂量(mg/d)
组别	例数	年龄(岁)	受教育年限(年)	病程时间(年)	住院时间(d)	奥氮平	利培酮
对照组	83	34.15±5.37	13.81±4.35	4.58±1.23	24.55±5.78	8.12±1.35	2.57±0.70
观察组	83	34.21±5.06	13.77±4.16	4.63±1.19	24.47±6.03	8.10±1.24	2.63±0.66
t值		0.074	0.061	0.266	0.087	0.099	0.568
P值		0.941	0.952	0.790	0.931	0.921	0.571

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表 2 认知适应训练方案课程内容

Table 2. Cognitive adaptation training program course content

课时	主题	内容
第1次	前瞻记忆	指导患者使用电子及纸质清单帮助记忆及组织日常活动，养成每天检查日历及待完成清单的习惯
第2次	沟通策略	指导患者在日常交流及会话时的注意事项及策略，组织患者进行会话练习
第3次	言语学习记忆	简化每天需要记忆的信息量，指导患者灵活使用便签及日历记录记忆活动，每天进行记忆策略练习
第4次	认知灵活性	指导患者“六步问题解决法”具体使用：发现问题—分析问题—潜在解决方法—规划—实施—评估，在生活中利用六步问题解决法制定解决策略
第5次	药物使用	药物使用方法、优点及注意事项，引导患者回顾以往服药依从性差的原因及危害，指导患者安全服药相关技能
第6次	生活技能训练	系统训练患者各项生活技能，包括个人卫生、生活自理、家居、物品管理等，提高患者自我照顾能力
第7次	社交训练	通过角色扮演进行社交训练，如与陌生人、家人、朋友等沟通和接触
第8次	医护人员建立有效联系	指导患者如何与医护人员建立有效的联系，例如获取医务人员电话、微信等，方便出院后沟通，指导患者如何清晰有效地报道病情、需求和服药情况等

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表 3 2组精神分裂症患者干预前后临床症状比较(x±s，分)

Table 3. Comparison of clinical symptoms of two groups in schizophrenic patients before and after intervention (x±s, points)

组别	例数	阴性症状		阳性症状		一般精神病理		总分
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	83	21.42±5.30	16.14±3.27^a	22.15±5.11	15.41±3.74^a	33.45±6.14	28.14±4.36^a	68.89±6.91	56.80±5.41^a
观察组	83	21.34±5.17	13.46±2.91^a	22.22±4.78	12.10±2.55^a	33.52±6.73	23.12±3.27^a	68.95±7.13	48.88±4.50^a
t值		0.098	5.578	0.091	6.662	0.070	8.392	0.055	10.357
P值		0.922	＜0.001	0.927	＜0.001	0.944	＜0.001	0.956	＜0.001
注：与同组干预前比较，^aP＜0.05。

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表 4 2组精神分裂症患者干预前后认知功能比较(x±s，分)

Table 4. Comparison of cognitive function between 2 groups of schizophrenic patients before and after intervention (x±s, points)

组别	例数	干预前	干预后
对照组	83	46.62±5.60	53.21±4.16^a
观察组	83	46.57±5.44	55.71±3.82^a
t值		0.058	4.033
P值		0.954	＜0.001
注：与同组干预前比较，^aP＜0.05。

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表 5 2组精神分裂症患者干预前后社会功能比较(x±s，分)

Table 5. Comparison of social function between two groups of schizophrenic patients before and after intervention (x±s, points)

组别	例数	GAF量表		PSP量表
组别	例数	干预前	干预后	干预前	干预后
对照组	83	52.48±6.88	68.92±6.90^a	52.17±5.28	58.91±5.39^a
观察组	83	52.53±7.34	75.43±5.83^a	52.23±5.34	63.35±4.63^a
t值		0.045	6.566	0.073	5.693
P值		0.964	＜0.001	0.942	＜0.001
注：与同组干预前比较，^aP＜0.05。

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表 6 2组精神分裂症患者服药依从性比较[例(%)]

Table 6. Comparison of medication compliance between two groups of patients with schizophrenia[cases (%)]

组别	例数	良好	一般	差
对照组	83	68(81.9)	12(14.5)	3(3.6)
观察组	83	77(92.8)	5(6.0)	1(1.2)
注：2组患者服药依从性比较，Z=4.416, P=0.036。

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参考文献(22)

[1]	DE NUNZIO A M, SCHWEISFURTH M A, GE N, et al. Relieving phantom limb pain with multimodal sensory-motor training[J]. J Neural Eng, 2018, 15(6): 066022. DOI: 10.1088/1741-2552/aae271.
[2]	CHEN X W, LIU F Q, YAN Z H, et al. Therapeutic effects of sensory input training on motor function rehabilitation after stroke[J]. Medicine (Baltimore), 2018, 97(48): e13387. DOI: 10.1097/MD.0000000000013387.
[3]	HUGUNIN J, YUAN Y Y, BAEK J, et al. Characteristics of working-age adults with schizophrenia newly admitted to nursing homes[J]. J Am Med Dir Assoc, 2022, 23(7): 1227-1235.e3. DOI: 10.1016/j.jamda.2021.11.019.
[4]	赵伟, 王玉玲, 刘志华, 等. 认知适应训练在严重精神障碍患者中的应用进展[J]. 中华护理杂志, 2023, 58(7): 885-890. ZHAO W, WANG Y L, et al. Progress in the application of cognitive adaptation training in patients with severe mental disorders[J]. Chinese Journal of Nursing, 2023, 58(7): 885-890.
[5]	SKOKOU M, MESSINIS L, NASIOS G, et al. Cognitive rehabilitation for patients with schizophrenia: a narrative review of moderating factors, strategies, and outcomes[J]. Adv Exp Med Biol, 2023: 193-199. DOI: 10.1007/978-3-031-31978-5_17.
[6]	罗晓东, 吕跃中, 贾雪珍, 等. 阿立哌唑联合丁螺环酮治疗精神分裂症的效果及安全性分析[J]. 中华全科医学, 2021, 19(1): 83-85, 123. doi: 10.16766/j.cnki.issn.1674-4152.001737 LUO X D, LV Y Z, JIA X Z, et al. Analysis of the efficacy and safety of aripiprazole combined with buspirone in the treatment of schizophrenia[J]. Chinese Journal of General Practice, 2021, 19(1): 83-85, 123. doi: 10.16766/j.cnki.issn.1674-4152.001737
[7]	朱晓丹. 急性期精神分裂症患者认知功能影响因素分析及干预研究[D]. 济南: 山东大学, 2020. ZHU X D. Analysis of influencing factors and intervention research on cognitive function in patients with acute schizophrenia[D]. Ji'nan: Shandong University, 2020.
[8]	秦知航, 陈琳霞. 量化评估下的个性化护理干预对青少年精神分裂症患者自我管理能力的影响[J]. 中华全科医学, 2021, 19(1): 86-88. doi: 10.16766/j.cnki.issn.1674-4152.001738 QIN Z H, CHEN L X. The impact of personalized nursing interventions under quantitative evaluation on self-management ability of adolescent schizophrenia patients[J]. Chinese Journal of General Practice, 2021, 19(1): 86-88. doi: 10.16766/j.cnki.issn.1674-4152.001738
[9]	杨旭, 李伟, 杨林, 等. 阿立哌唑与利培酮联合无抽搐电休克治疗精神分裂症的临床疗效[J]. 中国临床药理学杂志, 2023, 39(2): 178-181. https://www.cnki.com.cn/Article/CJFDTOTAL-GLYZ202302006.htm YANG X, LI W, YANG L, et al. The clinical efficacy of aripiprazole and risperidone combined with non convulsive electroconvulsive therapy in the treatment of schizophrenia[J]. Chinese Journal of Clinical Pharmacology, 2023, 39(2): 178-181. https://www.cnki.com.cn/Article/CJFDTOTAL-GLYZ202302006.htm
[10]	谢远丝, 张慧, 姚慧慧. 短程认知行为疗法联合药物治疗焦虑障碍的临床研究[J]. 海南医学, 2022, 33(9): 1145-1147. https://www.cnki.com.cn/Article/CJFDTOTAL-HAIN202209015.htm XIE Y S, ZHANG H, YAO H H. A clinical study of short-term cognitive behavioral therapy combined with medication in the treatment of anxiety disorder[J]. Hainan Medical Journal, 2022, 33(9): 1145-1147. https://www.cnki.com.cn/Article/CJFDTOTAL-HAIN202209015.htm
[11]	周晓月, 郑亚丽, 周仙琴. 医院-社区-家庭一体化延续护理对精神分裂症患者防治和康复的影响[J]. 中国康复, 2022, 37(1): 61-64. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLKF202201021.htm ZHOU X Y, ZHOU Y L, ZHOU X Q. The impact of hospital community family integrated continuous care on the prevention, treatment, and rehabilitation of schizophrenia patients[J]. China Rehabilitation, 2022, 37(1): 61-64. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLKF202201021.htm
[12]	兰琨熠, 张清, 沈悦好. GMAS、MMAS-8和SEAMS评估慢性病病人用药依从性效能的比较[J]. 护理研究, 2023, 37(13): 2322-2328. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ202313006.htm LAN K Y, ZHANG Q, SHEN Y H. Comparison of the efficacy of GMAS, MMAS-8, and SEAMS in evaluating medication compliance in chronic disease patients[J]. Chinese Nursing Research, 2023, 37(13): 2322-2328. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ202313006.htm
[13]	GONZÁLEZ-PANDO D, ALONSO-PÉREZ F, SUÁREZ-GIL P, et al. Diminished emotional expression in schizophrenia: an interdisciplinary approach based on behavioral interventions[J]. Psicothema, 2018, 30(1): 8-13.
[14]	USLU E, BULDUKOGLU K. Randomized controlled trial of the effects of nursing care based on a telephone intervention for medication adherence in schizophrenia[J]. Perspect Psychiatr Care, 2020, 56(1): 63-71.
[15]	任维聪, 王汉林, 张志杰. 自适应认知训练对老年人认知功能的改善[J]. 中华老年医学杂志, 2021, 40(6): 788-792. https://cdmd.cnki.com.cn/Article/CDMD-10159-1021870087.htm REN W C, WANG H L, ZHANG Z J. Adaptive cognitive training improves cognitive function in the elderly[J]. Chinese Journal of Geriatrics, 2021, 40(6): 788-792. https://cdmd.cnki.com.cn/Article/CDMD-10159-1021870087.htm
[16]	KIDD S A, KERMAN N, ERNEST D, et al. A pilot study of a family cognitive adaptation training guide for individuals with schizophrenia[J]. Psychiatr Rehabil J, 2018, 41(2): 109-117.
[17]	樊献丽, 武振宁, 武克文, 等. 计算机认知矫正治疗联合社交技能训练对精神分裂症患者阴性症状的效果研究[J]. 中国基层医药, 2023, 30(2): 235-239. https://www.cnki.com.cn/Article/CJFDTOTAL-XDZD202112066.htm FAN X L, WU Z N, WU K W, et al. A study on the effect of computer cognitive correction therapy combined with social skills training on negative symptoms in patients with schizophrenia[J]. Chinese Grassroots Medicine, 2023, 30(2): 235-239. https://www.cnki.com.cn/Article/CJFDTOTAL-XDZD202112066.htm
[18]	MORORÓ L G, GUIMARÃES A L, COSTA A C, et al. Association between motivation and engagement with changes in cognition and symptoms after digital cognitive training in schizophrenia[J]. Schizophr Res, 2023, 251: 1-9.
[19]	VAN DAM M, VAN WEEGHEL J, STIEKEMA A, et al. Barriers and facilitators to implementation of cognitive adaptation training in long-term inpatient facilities for people diagnosed with severe mental illness: a nursing perspective[J]. J Psychiatr Ment Health Nurs, 2022, 29(4): 568-577.
[20]	裴建琴, 张艳, 陆江波, 等. 团体感觉运动训练对老年精神分裂症患者认知功能、阴性症状的干预效果研究[J]. 军事护理, 2022, 39(9): 13-16. https://www.cnki.com.cn/Article/CJFDTOTAL-JFHL202209004.htm PEI J Q, ZHANG Y, LU J B, et al. A study on the intervention effect of team sensory exercise training on cognitive function and negative symptoms in elderly patients with schizophrenia[J]. Military Nursing, 2022, 39(9): 13-16. https://www.cnki.com.cn/Article/CJFDTOTAL-JFHL202209004.htm
[21]	KELSVEN S, BRUMMIT K, DEVOE D, et al. Cognitive-behavioral social skills training adapted for youth at clinical high risk for psychosis[J]. J Cogn Psychother, 2022: JCP-2021-0029. R1. DOI: 10.1891/JCP-2021-0029.
[22]	周亚楠, 翟金国, 陈敏. 首发精神分裂症精神病未治期对认知功能和社会功能的影响[J]. 中国神经精神疾病杂志, 2018, 44(1): 38-43. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSJJ201801010.htm ZHOU Y N, ZHAI J G, CHEN M. Effects of untreated first episode schizophrenia on cognitive function and social function[J]. Chinese Journal of Neuropsychiatric Disorders, 2018, 44(1): 38-43. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSJJ201801010.htm