基于复元理念的个体化干预对精神分裂症合并糖尿病患者的护理研究

林玲; 张毅; 何美

doi:10.16766/j.cnki.issn.1674-4152.003270

基于复元理念的个体化干预对精神分裂症合并糖尿病患者的护理研究

doi: 10.16766/j.cnki.issn.1674-4152.003270

上海市精神卫生中心B3病区，上海 201108

基金项目:

上海市科学技术委员会科技计划项目 21Y11905700

详细信息

通讯作者:
林玲, E-mail: linling0814@126.com

中图分类号: R749.3R587.1R473.74
计量
- 文章访问数: 183
- HTML全文浏览量: 59
- PDF下载量: 11
- 被引次数: 0
出版历程
- 收稿日期: 2023-07-26
- 网络出版日期: 2024-01-13

Study on nursing care of schizophrenia patients with diabetes by individualized intervention based on recovery concept

B3 Ward, Shanghai Mental Health Center, Shanghai 201108, China

摘要

摘要: 目的精神分裂症合并糖尿病的护理需高度重视，本研究探讨基于复元理念的个体化护理干预的应用效果。方法选取2020年9月—2022年8月上海市精神卫生中心收治的122例精神分裂症合并糖尿病患者，采用随机数表法分为对照组和观察组，每组各61例。对照组实施常规护理干预，观察组实施基于复元理论的个体化护理干预。2组均干预6个月，比较2组干预前后自知力与治疗态度[自知力与治疗态度问卷(ITAQ)]、病耻感[精神疾病内在病耻感调查表(ISMI)]、治疗依从性、临床精神症状[阳性与阴性症状量表(PANSS)]、血糖指标[空腹血糖(FPG)、糖化血红蛋白(HbA1c)及餐后2 h血糖(2hPG)]，并记录2组干预6个月后血糖达标情况及干预期间精神分裂症疾病复发情况。结果干预后，观察组ITAQ量表评分高于对照组(P＜0.05)，ISMI各维度评分及总分低于对照组(P＜0.05)。观察组依从性优良率为91.53%(54/59)，高于对照组[77.97%(46/59), P＜0.05]。干预后，观察组PANSS各维度评分及总分低于对照组(P＜0.05)，FPG、2hPG及HbA1c水平低于对照组(P＜0.05)。干预6个月后，观察组血糖达标率高于对照组[74.58%(44/59)vs. 55.93%(33/59), P＜0.05]。结论基于复元理念的个体化干预能提升精神分裂症合并糖尿病患者的自知力，降低病耻感，利于其精神康复及血糖稳定。
- 精神分裂症 /
- 糖尿病 /
- 复元理念 /
- 临床精神症状 /
- 控糖效果
Abstract: Objective The nursing of schizophrenia complicated with diabetes should be paid more attention. This study discusses the application effect of individualized nursing intervention based on the concept of rehabilitation. Methods A total of 122 patients with schizophrenia combined with diabetes admitted to Shanghai Mental Health Center from September 2020 to August 2022 were selected and divided into control group and observation group by random number table method, with 61 cases in each group. The control group implemented routine nursing intervention, while the observation group implemented individualized nursing intervention based on recovery theory. Both groups were intervened for 6 months, and their self-awareness and treatment attitude [insight and treatment attitude questionnaire (ITAQ)], stigma [internalized stigma of mental illness inventory (ISMI)], treatment compliance, clinical psychiatric symptoms [positive and negative syndrome scale (PANSS)], blood glucose indicators [fasting blood glucose (FPG), glycated hemoglobin (HbAlc) and 2 hour postprandial plasma glucose (2hPG)] were compared before and after the intervention, and the blood glucose level after 6 months of intervention in both groups were recorded, as well as the recurrence of schizophrenia during the intervention period. Results After intervention, the ITAQ scale score in the observation group was higher than that in the control group (P < 0.05), while the ISMI scores and total scores in all dimensions were lower than those in the control group (P < 0.05). The excellent and good compliance rate in the observation group was 91.53% (54/59), which was higher than 77.97% (46/59) in the control group (P < 0.05). After intervention, the PANSS scores in all dimensions and total scores in the observation group were lower than those in the control group (P < 0.05), and the levels of FPG, 2 h PG, and HbA1c were lower than those in the control group (P < 0.05). After 6 months of intervention, the blood glucose compliance rate in the observation group was higher than that in the control group [74.58% (44/59) vs. 55.93% (33/59), P < 0.05]. Conclusion Individualized intervention based on the concept of recovery can improve the insight of schizophrenic patients with diabetes, reduce their sense of shame, and facilitate their mental rehabilitation and blood sugar stability.
- Schizophrenia /
- Diabetes /
- Concept of recovery /
- Clinical psychiatric symptoms /
- Sugar control effect

HTML全文

表 1 2组精神分裂症合并糖尿病患者一般资料比较

Table 1. Comparison of general data between two groups of patients with schizophrenia and diabetes

组别	例数	性别(例)		年龄 (x±s，岁)	精神分裂症病程 (x±s，年)	糖尿病病程 (x±s，年)	受教育年限 (x±s，年)	婚姻状况[例(%)]
组别	例数	男性	女性	年龄 (x±s，岁)	精神分裂症病程 (x±s，年)	糖尿病病程 (x±s，年)	受教育年限 (x±s，年)	已婚	未婚	其他
对照组	59	39	20	51.53±10.34	5.42±1.34	3.52±1.01	12.35±2.96	39(66.10)	10(16.95)	10(16.95)
观察组	59	33	26	52.26±10.21	5.51±1.38	3.57±1.06	12.57±3.12	35(59.32)	16(27.12)	8(13.56)
统计量		1.283^a		0.386^b	0.360^b	0.262^b	0.393^b	1.823^a
P值		0.257		0.700	0.720	0.794	0.695	0.402
注：^a为χ²值，^b为t值。

下载: 导出CSV

表 2 2组精神分裂症合并糖尿病患者ITAQ量表评分比较(x±s，分)

Table 2. Comparison of ITAQ scores between two groups of patients with schizophrenia and diabetes (x±s, points)

组别	例数	干预前	干预后
对照组	59	10.52±3.68	13.86±4.67^a
观察组	59	10.35±3.52	15.83±5.12^a
t值		0.256	2.184
P值		0.798	0.031
注：与同组干预前比较，^aP＜0.05。

下载: 导出CSV

表 3 2组精神分裂症合并糖尿病患者ISMI评分比较(x±s，分)

Table 3. Comparison of ISMI scores between two groups of patients with schizophrenia and diabetes (x±s, points)

组别	例数	疏远		刻板认同		歧视经历		社会退缩		病耻感抵抗		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	干预前	干预后	干预前	干预后
对照组	59	18.95±2.45	16.22±2.09^a	21.12±3.25	18.53±2.84^a	15.47±2.29	13.21±1.86^a	18.75±2.37	15.34±2.03^a	16.37±2.71	13.98±2.06^a	90.66±6.35	77.10±5.26^a
观察组	59	19.09±2.53	14.23±1.84^a	21.33±3.36	16.31±2.55^a	15.58±2.38	11.23±1.61a	18.61±2.23	13.61±1.79^a	16.25±2.57	12.48±1.79^a	90.86±6.44	67.86±4.67^a
t值		0.305	5.489	0.345	4.468	0.256	6.182	0.330	4.910	0.247	4.222	0.170	10.090
P值		0.761	＜0.001	0.731	＜0.001	0.799	＜0.001	0.742	＜0.001	0.806	＜0.001	0.865	＜0.001
注：与同组干预前比较，^aP＜0.05。

下载: 导出CSV

表 4 2组精神分裂症合并糖尿病患者治疗依从性优良率比较

Table 4. Comparison of good to good ratio of treatment compliance between two groups of patients with schizophrenia and diabetes

组别	例数	完全依从 [例(%)]	部分依从 [例(%)]	不依从 [例(%)]	依从性优良率(%)
对照组	59	25(42.37)	21(35.60)	13(22.03)	77.97(46/59)
观察组	59	38(64.41)	16(27.12)	5(8.47)	91.53(54/59)
注：2组依从性优良率比较，χ²=4.196，P=0.041。

下载: 导出CSV

表 5 2组精神分裂症合并糖尿病患者PANSS评分比较(x±s，分)

Table 5. Comparison of PANSS scores between two groups of patients with schizophrenia and diabetes (x±s, points)

组别	例数	阳性症状		阴性症状		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	59	16.59±5.31	14.46±4.52^a	21.72±6.26	17.53±5.34^a	37.94±8.24	34.45±5.79^a	76.25±8.51	66.44±7.18^a
观察组	59	17.06±5.42	11.81±3.74^a	21.34±6.17	15.08±3.61^a	38.03±8.38	31.25±5.13^a	76.43±8.82	58.14±6.67^a
t值		0.476	3.470	0.332	2.706	0.059	3.177	0.112	6.505
P值		0.635	0.001	0.740	0.008	0.953	0.002	0.910	＜0.001
注：与同组干预前比较，^aP＜0.05。

下载: 导出CSV

表 6 2组精神分裂症合并糖尿病患者FPG、2hPG及HbA1c水平比较(x±s)

Table 6. Comparison of FPG, 2hPG and HbA1c levels between two groups of patients with schizophrenia and diabetes (x±s)

组别	例数	FPG(mmoL/L)		2hPG(mmoL/L)		HbA1c(%)
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
对照组	59	9.14±2.53	7.53±1.12^a	12.52±2.63	9.42±1.62^a	8.64±2.11	7.13±1.74^a
观察组	59	9.23±2.61	6.65±0.87^a	12.44±2.56	7.83±1.47^a	8.71±2.16	6.21±1.54^a
t值		0.190	4.766	0.164	5.583	0.178	3.041
P值		0.850	＜0.001	0.867	＜0.001	0.859	0.003
注：与同组干预前比较，^aP＜0.05。

下载: 导出CSV

参考文献(18)

[1]	SABE M, PILLINGER T, KAISER S, et al. Half a century of research on antipsychotics and schizophrenia: a scientometric study of hotspots, nodes, bursts, and trends[J]. Neurosci Biobehav Rev, 2022, 136: 104608. DOI: 10.1016/j.neubiorev.2022.104608.
[2]	MIZUKI Y, SAKAMOTO S, OKAHISA Y, et al. Mechanisms underlying the comorbidity of schizophrenia and type 2 diabetes mellitus[J]. Int J Neuropsychopharmacol, 2021, 24(5): 367-382. doi: 10.1093/ijnp/pyaa097
[3]	YANG F D, MA Q Y, LIU J, et al. Prevalence and major risk factors of type 2 diabetes mellitus among adult psychiatric inpatients from 2005 to 2018 in Beijing, China: a longitudinal observational study[J]. BMJ Open Diabetes Res Care, 2020, 8(1): e000996. DOI: 10.1136/bmjdrc-2019-000996.
[4]	LI S, CHEN D C, XIU M H, et al. Diabetes mellitus, cognitive deficits and serum BDNF levels in chronic patients with schizophrenia: a case-control study[J]. J Psychiatr Res, 2021, 134(33): 39-47.
[5]	陈颖, 周春芬, 张倬秋, 等. 以复元理念为导向的精神康复技术课程在精神科护士继续教育中的应用[J]. 济宁医学院学报, 2021, 44(4): 293-295, 299. doi: 10.3969/j.issn.1000-9760.2021.04.016 CHEN Y, ZHOU C F, ZHANG Z Q, et al. The application of mental rehabilitation course oriented by recovery in the continuing education for psychiatric nurses[J]. Journal of Jining Medical University, 2021, 44(4): 293-295, 299. doi: 10.3969/j.issn.1000-9760.2021.04.016
[6]	范佳芮. 复元模式下社会工作介入精神疾病康复的研究: 以B社区精神康复服务中心为例[D]. 广州: 华南理工大学, 2021. FAN J R. A study on the intervention of social work in the rehabilitation of mental disorders under the revitalization mode: taking the b community mental rehabilitation service center as an example[D]. Guangzhou: South China University of Technology, 2021.
[7]	American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Fourth Edition, text revision[M]. Washington DC: American Psychiatric Association, 2000.
[8]	田勍, 洪天配. 美国糖尿病学会2017年版糖尿病医学诊疗标准的解读[J]. 中国糖尿病杂志, 2017, 25(7): 577-581. doi: 10.3969/j.issn.1006-6187.2017.07.001 TIAN Q, HONG T P. Interpretation of ADA standards of medical care in diabetes-2017[J]. Chinese Journal of Diabetes, 2017, 25(7): 577-581. doi: 10.3969/j.issn.1006-6187.2017.07.001
[9]	顾陈英, 陈姬. 院外延伸护理对精神分裂症合并糖尿病患者自我管理水平和控糖效果的影响[J]. 临床与病理杂志, 2022, 42(9): 2242-2247. GU C Y, CHEN J. Effect of extended nursing care outside hospital on self-management level and glucose control in patients with schizophrenia complicated with diabetes mellitus[J]. Journal of Clinical and Pathological Research, 2022, 42(9): 2242-2247.
[10]	高华, 余西金, 吕锋. 自知力与治疗态度问卷的信效度测定[J]. 中国心理卫生杂志, 1998(2): 9-10. GAO H, YU X J, LYU F. Reliability and validity of the self knowledge and treatment attitude questionnaire[J]. Chinese Mental Health Journal, 1998(2): 9-10.
[11]	杨琳, 宋立升, 曹雍华, 等. 精神疾病内在病耻感调查表在精神分裂症患者中的信度和效度[J]. 临床精神医学杂志, 2012, 22(3): 166-168. YANG L, SONG L S, CAO Y H, et al. The reliability and validity of internalized stigma of mental illness inventory in patients with schizophrenia[J]. Journal of Clinical Psychiatry, 2012, 22(3): 166-168.
[12]	司天梅, 杨建中, 舒良, 等. 阳性和阴性症状量表(PANSS, 中文版)的信、效度研究[J]. 中国心理卫生杂志, 2004, 18(1): 45-47. SI T M, YANG J Z, SHU L, et al. The reliability, validity of PANSS and its implication[J]. Chinese Mental Health Journal, 2004, 18(1): 45-47.
[13]	HUO L J, ZHANG G Y, DU X D, et al. The prevalence, risk factors and clinical correlates of diabetes mellitus in Chinese patients with schizophrenia[J]. Schizophr Res, 2020, 218: 262-266. doi: 10.1016/j.schres.2019.12.029
[14]	杨志磊, 高存友, 崔东红, 等. 慢性精神分裂症患者共病糖尿病的临床调查分析[J]. 国际精神病学杂志, 2021, 48(3): 402-405. YANG Z L, GAO C Y, CUI D H, et al. Survey of comorbidities diabetes in patients with chronic schizophrenia[J]. Journal of International Psychiatry, 2021, 48(3): 402-405.
[15]	单慧惠, 梅文卓, 钱丹玲, 等. 引导式教育康复训练方案对住院精神分裂症患者自知力、社会功能及生活质量的影响[J]. 当代护士(上旬刊), 2022, 29(4): 132-135. SHAN H H, MEI W Z, QIAN D L, et al. The impact of guided educational rehabilitation training programs on self-awareness, social function, and quality of life in hospitalized schizophrenia patients[J]. Modern Nurse(First Edition), 2022, 29(4): 132-135.
[16]	穆晞园, 张晨, 王晓蓉. 精神分裂症患者治疗依从性的相关因素分析[J]. 中华全科医学, 2021, 19(12): 2081-2083. doi: 10.16766/j.cnki.issn.1674-4152.002242 MU X Y, ZHANG C, WANG X R. Analysis of related factors on treatment compliance in patients with schizophrenia[J]. Chinese Journal of General Practice, 2021, 19(12): 2081-2083. doi: 10.16766/j.cnki.issn.1674-4152.002242
[17]	曾彦, 邵明学, 徐丽霞. 针对性护理对住院精神分裂症伴2型糖尿病患者血糖控制及生活能力的影响[J]. 糖尿病新世界, 2023, 26(7): 136-139. ZENG Y, SHAO M X, XU L X. Effect of targeted nursing on blood glucose control and living ability of inpatients with schizophrenia and type 2 diabetes mellitus[J]. Diabetes New World, 2023, 26(7): 136-139.
[18]	陈玲, 刘泽伟. 精神健康社会工作服务的创新实践: 复元理论下的案例研究[J]. 社会工作与管理, 2021, 21(6): 44-49. CHEN L, LIU Z W. Innovative practice of recovery theory: a case study of mental health social work[J]. Social Work and Management, 2021, 21(6): 44-49.