生命树叙事法联合感觉运动训练在慢性稳定期精神分裂症患者中的应用

茅丽利; 沈银萍; 潘小芳

doi:10.16766/j.cnki.issn.1674-4152.003599

生命树叙事法联合感觉运动训练在慢性稳定期精神分裂症患者中的应用

doi: 10.16766/j.cnki.issn.1674-4152.003599

湖州市第三人民医院精神科，浙江湖州 313000

基金项目:

浙江省医药卫生科技计划项目 2023KY1182

详细信息

通讯作者:
茅丽利, E-mail: 15957245045@163.com

中图分类号: R749.3 R493
计量
- 文章访问数: 12
- HTML全文浏览量: 6
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2024-01-09
- 网络出版日期: 2024-09-05

Application of tree of life narrative combined sensorimotor training in chronic stable schizophrenia

Psychiatric Department, Huzhou Third Municipal Hospital, Huzhou, Zhejiang 313000, China

摘要

摘要: 目的探究生命树叙事法联合感觉运动训练对慢性稳定期精神分裂症患者心理状况、临床症状、认知功能以及社会功能的影响。方法采用随机数字表法将2022年3月—2023年3月在湖州市第三人民医院就诊的97例慢性稳定期精神分裂症患者分为对照组(49例，常规护理)和试验组(48例，生命树叙事法联合感觉运动训练+常规护理)，比较2组干预效果。结果试验组干预后自我效能感量表(GSES)评分高于对照组(P＜0.05)；病耻感量表(SSMI-C)评分低于对照组(P＜0.05)；阳性和阴性症状量表(PANSS)总分[(36.37±5.35)分]低于对照组[(46.83±7.44)分, P＜0.05]；威斯康星卡片分类测验(WCST)中持续错误次数[(7.94±2.11)次]低于对照组[(9.78±2.56)次, P＜0.05]，正确反应次数[(51.92±6.34)次]、概念化水平百分数[(65.77±7.23)%]高于对照组[(46.71±7.26)次、(60.33±4.99)%, 均P＜0.05]；社会功能评定量表(SSPI)总分高于对照组(P＜0.05)。结论生命树叙事法联合感觉运动训练可提高慢性稳定期精神分裂症患者自我效能感，降低病耻感，改善临床症状和认知功能，提高社会功能。
- 精神分裂症 /
- 生命树叙事法 /
- 感觉运动训练 /
- 病耻感 /
- 认知功能
Abstract: Objective To explore the effects of the tree of life narration combined with sensorimotor training on psychological status, clinical symptoms, cognitive function, and social function of patients with chronic stable schizophrenia. Methods A total of 97 patients with chronic stable schizophrenia treated in Huzhou Third Municipal Hospital from March 2022 to March 2023 were divided into a control group (49 cases, conventional care) and an experimental group (48 cases, tree of life narrative method combined with sensory-motor training+routine care) by random number table method. Results The score of general self-efficacy scale (GSES) in the experimental group was higher than that in the control group (P < 0.05). The score of Chinese version of stigma scale for mental illness (SSMI-C) in the experimental group was lower than that of the control group (P < 0.05). The total score of PANSS (36.37±5.35) in the experimental group was lower than that of the control group (46.83±7.44, P < 0.05). The number of persistent errors (7.94±2.11) in the Wisconsin card sorting test (WCST) in the experimental group was lower than that in the control group (9.78±2.56, P < 0.05), the number of correct reactions (51.92±6.34), and percentage of conceptualization (65.77±7.23)% in the WCST in the experimental group were higher than those in the control group [46.71±7.26, (60.33±4.99)%, P < 0.05]. The total score of scale of social function in psychosis inpatients (SSPI) in the experimental group was higher than that in the control group (P < 0.05). Conclusion The tree of life narrative combined with sensorimotor training can improve self-efficacy, reduce stigma, improve clinical symptoms and cognitive function, and improve social function in chronic stable schizophrenia patients.
- Schizophrenia /
- Narrative of tree of life /
- Sensorimotor training /
- Stigma /
- Cognitive function

HTML全文

表 1 2组精神分裂症患者一般资料比较

Table 1. Comparison of general data between two groups in schizophrenia patient

组别	例数	性别(例)		年龄(x±s，岁)	受教育年限(x±s，年)	婚姻状况(例)		病程(x±s，年)
组别	例数	男性	女性	年龄(x±s，岁)	受教育年限(x±s，年)	已婚	未婚/离异	病程(x±s，年)
对照组	49	24	25	39.89±5.67	11.57±2.45	35	14	3.23±0.66
试验组	48	21	27	38.23±8.01	12.53±3.27	40	8	3.11±0.74
统计量		0.267^a		1.180^b	1.639^b	1.960^a		0.843^b
P值		0.606		0.240	0.104	0.162		0.401
注：^a为χ²值，^b为t值。

下载: 导出CSV

表 2 生命树叙事法干预方案

Table 2. Intervention program using the tree of life narrative method

阶段	活动主题	活动内容
初期	话期待	开始热身：找朋友
		主要活动：团体介绍、团体期望
		结束时刻：患者表达感受，组织者总结
	画支持	开始热身：手牵手
		主要活动：画生命树、分享生命树
		结束时刻：患者表达感受，组织者总结
中期	享故事	开始热身：松鼠与大树
		主要活动：我的故事、新的生命树
		结束时刻：患者表达感受，组织者总结
	聊经验	开始热身：抓虫子
		主要活动：经验分享、成功体验、困扰讨论
		结束时刻：患者表达感受，组织者总结
后期	悟收获	开始热身：心有千千结
		主要活动：总结成长、分享期待、送上祝福
		结束时刻：患者表达感受，组织者总结

下载: 导出CSV

表 3 2组精神分裂症患者干预前后SSMI-C评分比较(x±s，分)

Table 3. Comparison of SSMI-C scores before and after intervention between two groups in schizophrenia patients (x±s, points)

组别	例数	歧视		病情掩饰		积极效应		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
试验组	48	21.34±4.21	16.70±3.11^b	17.33±3.10	14.56±3.92^b	13.45±2.03	10.44±2.17^b	52.12±6.73	41.77±5.24^b
对照组	49	21.66±3.70	20.51±4.11	17.52±3.29	16.83±3.24	13.20±3.24	13.02±3.11	52.38±7.24	50.36±6.11
统计量		0.398^a	18.901^c	0.293^a	15.671^c	0.454^a	16.781^c	0.183^a	17.904^c
P值		0.692	< 0.001	0.771	0.003	0.651	< 0.001	0.855	< 0.001
注：^a为t值，^c为F值；与同组干预前比较，^bP < 0.05。

下载: 导出CSV

表 4 2组精神分裂症患者干预前后PANSS评分比较(x±s，分)

Table 4. Comparison of PANSS scores before and after intervention between two groups in schizophrenia patients (x±s, points)

组别	例数	阳性症状		阴性症状		一般症状		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
试验组	48	18.34±4.56	10.35±3.22^b	14.89±2.47	9.46±2.49^b	26.67±6.33	16.56±6.09^b	59.90±5.51	36.37±5.35^b
对照组	49	17.67±3.75	14.04±3.40^b	14.22±3.58	11.56±3.07^b	26.24±7.04	21.23±5.33^b	58.13±7.21	46.83±7.44^b
统计量		0.792^a	17.893^c	1.071^a	16.324^c	0.316^a	17.098^c	1.356^a	19.031^c
P值		0.431	< 0.001	0.287	< 0.001	0.753	< 0.001	0.178	< 0.001
注：^a为t值，^c为F值；与同组干预前比较，^bP < 0.05。

下载: 导出CSV

表 5 2组精神分裂症患者干预前后认知功能比较(x±s)

Table 5. Comparison of cognitive function before and after intervention between two groups in schizophrenia patients (x±s)

组别	例数	持续错误次数(次)		正确反应次数(次)		概念化水平百分数(%)
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
试验组	48	13.45±2.17	7.94±2.11^b	35.67±5.23	51.92±6.34^b	54.67±7.56	65.77±7.23^b
对照组	49	13.88±3.09	9.78±2.56^b	35.89±5.44	46.71±7.26^b	55.01±7.28	60.33±4.99^b
统计量		0.792^a	20.091^c	0.203^a	18.951^c	0.226^a	21.034^c
P值		0.431	< 0.001	0.840	< 0.001	0.822	< 0.001
注：^a为t值，^c为F值；与同组干预前比较，^bP < 0.05。

下载: 导出CSV

表 6 2组精神分裂症患者干预前后SSPI评分比较(x±s，分)

Table 6. Comparison of SSPI scores before and after intervention between two groups in patients with schizophrenia (x±s, points)

组别	例数	日常生活能力		社会性活动技能		运动和交往		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
试验组	48	8.78±1.90	13.45±2.36^b	8.25±1.23	14.57±3.64^b	11.40±2.37	15.79±3.29^b	28.39±4.60	43.81±5.77^b
对照组	49	9.11±2.10	11.23±2.17^b	8.03±1.77	10.98±2.12^b	11.72±2.44	13.24±3.10^b	28.86±5.60	35.45±6.24^b
统计量		0.811^a	20.098^c	0.709^a	15.671^c	0.655^a	18.453^c	0.451^a	16.567^c
P值		0.419	< 0.001	0.480	< 0.001	0.514	< 0.001	0.653	< 0.001
注：^a为t值，^c为F值；与同组干预前比较，^bP < 0.05。

下载: 导出CSV

参考文献(21)

[1]	SMIGIELSKI L, JAGANNATH V, RÖSSLER W, et al. Epigenetic mechanisms in schizophrenia and other psychotic disorders: a systematic review of empirical human findings[J]. Mol Psychiatry, 2020, 25(8): 1718-1748.
[2]	HUANG Y Q, WANG Y, WANG H, et al. Prevalence of mental disorders in China: a cross sectional epidemiological study[J]. Lancet Psychiatry, 2019, 6(3): 211-224.
[3]	杨婷, 翁荣珍, 任小群. 精神分裂症患者病耻感水平及其危险因素分析[J]. 当代护士(上旬刊), 2023, 30(10): 84-86. https://www.cnki.com.cn/Article/CJFDTOTAL-DDZT202310023.htm YANG T, WENG R Z, REN X Q. The level of stigma and its risk factors in patients with schizophrenia[J]. Modern Nurse(Previous publication), 2023, 30(10): 84-86. https://www.cnki.com.cn/Article/CJFDTOTAL-DDZT202310023.htm
[4]	黄碧华, 陈燕华. 生命树叙事疗法在减轻长期住院慢性稳定期精神分裂症患者病耻感中的应用[J]. 中国医学伦理学, 2023, 36(1): 83-88. https://www.cnki.com.cn/Article/CJFDTOTAL-XNLX202301015.htm HUANG B H, CHEN Y S. Application of life tree narrative therapy in alleviating stigma among long-term hospitalized patients with chronic stable schizophrenia[J]. Chinese Medical Ethics, 2023, 36(1): 83-88. https://www.cnki.com.cn/Article/CJFDTOTAL-XNLX202301015.htm
[5]	蒋菊芳, 陆江波, 裴建琴, 等. 感觉运动训练在老年精神分裂症患者中的应用效果[J]. 中华护理杂志, 2022, 57(2): 151-157. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHHL202202004.htm JIANG J F, LU J B, PEI J Q, et al. Effect of sensorimotor training in elderly patients with schizophrenia[J]. Chinese Journal of Nursing, 2022, 57(2): 151-157. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHHL202202004.htm
[6]	郝伟, 陆林. 精神病学[M]. 8版. 北京: 人民卫生出版社, 2018 : 46-47. HAO W, LU L. Psychiatry[M]. 8th edition. Beijing: People's Medical Publishing House, 2018: 46-47.
[7]	王才康, 胡中锋, 刘勇. 一般自我效能感量表的信度和效度研究[J]. 应用心理学, 2001, 7(1): 37-40. https://www.cnki.com.cn/Article/CJFDTOTAL-YXNX200101006.htm WANG C K, HU Z F, LIU Y. Evidences for reliability and validity of the Chinese version of general self efficacy scale[J]. Chinese Journal of Applied Psychology, 2001, 7(1): 37-40. https://www.cnki.com.cn/Article/CJFDTOTAL-YXNX200101006.htm
[8]	耿峰, 董毅, KING M, 等. 精神疾病病耻感量表中文版在精神分裂症患者中应用的信效度[J]. 中国心理卫生杂志, 2010, 24(5): 343-346. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXWS201005010.htm GENG F, DONG Y, KING M, et al. Reliability and validity of the Chinese-version of Stigma Scale for Mental Illness[J]. Chinese Mental Health Journal, 2010, 24(5): 343-346. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXWS201005010.htm
[9]	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. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXWS201007003.htm 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. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXWS201007003.htm
[10]	邹义壮, 崔界峰, 王健, 等. 精神分裂症认知功能成套测验中文版临床信度及效度的研究[J]. 中华精神科杂志, 2009, 42(1): 29-33. ZHOU Y Z, CUI J F, WANG J, et al. Clinical reliability and validity of the Chinese version of measurement and treatment research to improve cognition in schizophrenia consensus cognitive battery[J]. Chinese Journal of Psychiatry, 2009, 42(1): 29-33.
[11]	张作记. 行为医学量表手册[M/CD]. 北京: 中华医学电子音像出版社, 2005: 15-17. ZHANG Z J. Manual of Behavioral Medicine Scale[M/CD]. Beijing: China Medical Electronic Audio-Visual Publishing House, 2005: 15-17.
[12]	赵婧婧, 郗小玲, 王荣, 等. "智慧农场"职业化运营模式训练对慢性精神分裂症患者社会功能及生活质量的影响[J]. 护士进修杂志, 2022, 37(7): 639-642. https://www.cnki.com.cn/Article/CJFDTOTAL-FSJX202207013.htm ZHAO J J, XI X L, WANG R, et al. Effect of'smart farm'professional operation mode training on social function and quality of life of patients with chronic schizophrenia[J]. Journal of Nurses Training, 2022, 37(7): 639-642. https://www.cnki.com.cn/Article/CJFDTOTAL-FSJX202207013.htm
[13]	吴诗诗, 刘宇, 林可可, 等. 自我效能在社区2型糖尿病患者角色需求认知和自我管理间的中介效应[J]. 中华全科医学, 2021, 19(4): 621-624, 666. doi: 10.16766/j.cnki.issn.1674-4152.001877 WU S S, LIU Y, LIN K K, et al. The mediating effect of diabetes self-efficacy between perceived role demands and diabetes self-management among community patients with type 2 diabetes[J]. Chinese Journal of General Practice, 2021, 19(4): 621-624, 666. doi: 10.16766/j.cnki.issn.1674-4152.001877
[14]	罗琳, 张金玲, 黄洁. 影响慢性精神分裂症康复训练患者自我效能的因素分析[J]. 护理实践与研究, 2021, 18(13): 2007-2010. https://www.cnki.com.cn/Article/CJFDTOTAL-HLSJ202113032.htm LUO L, ZHANG J L, HUANG J. Analysis of factors affecting self-efficacy in rehabilitation training patients with chronic schizophrenia[J]. Nursing Practice and Research, 2021, 18(13): 2007-2010. https://www.cnki.com.cn/Article/CJFDTOTAL-HLSJ202113032.htm
[15]	杜今, 张红宇, 乔雨晨. 游戏治疗提升阿尔茨海默病患者认知能力及自我效能感的干预研究[J]. 中国康复, 2023, 38(7): 426-429. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLKF202307009.htm DU J, ZHANG H Y, QIAO Y C. The intervention study of play therapy to improve cognitive function and self-efficacy of elderly patients with dementia[J]. Chinese Journal of Rehabilitation, 2023, 38(7): 426-429. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLKF202307009.htm
[16]	SAFFARI M, CHANG K C, CHEN J S, et al. Sleep quality and self-stigma mediate the association between problematic use of social media and quality of life among people with schizophrenia in taiwan: a longitudinal study[J]. Psychiatry Investig, 2023, 20(11): 1034-1044.
[17]	周必芬, 曹江, 康艳宝, 等. 康复期精神分裂症患者病耻感影响因素及护理对策[J]. 中国基层医药, 2021, 28(3): 463-466. ZHOU B F, CAO J, KANG Y B, et al. Influential factors of stigma in convalescent schizophrenic patients and nursing countermeasures[J]. Chinese Journal of Primary Medicine and Pharmacy, 2021, 28(3): 463-466.
[18]	AHMAD I, VERMA S, NOOHU M M, et al. Sensorimotor and gait training improves proprioception, nerve function, and muscular activation in patients with diabetic peripheral neuropathy: a randomized control trial[J]. J Musculoskelet Neuronal Interact, 2020, 20(2): 234-248.
[19]	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. Effect of group sensorimotor 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
[20]	宋思妍, 黄菁芸. 感觉运动训练对老年精神分裂症患者认知水平、自我效能和日常生活能力的影响[J]. 中国医学创新, 2023, 20(23): 64-68. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYCX202323015.htm SONG S Y, HUANG J Y. Effects of sensorimotor training on cognitive level, self-efficacy and ability of daily living in elderly patients with schizophrenia[J]. Medical Innovation of China, 2023, 20(23): 64-68. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYCX202323015.htm
[21]	王玲. 感觉运动锻炼联合团体绘画艺术对改善稳定期老年精神分裂症患者认知及社会功能的效果[J]. 上海护理, 2023, 23(8): 53-56. https://www.cnki.com.cn/Article/CJFDTOTAL-SHHL202308012.htm WANG L. Effect of sensorimotor exercise combined with group painting on improving cognitive and social functions among elderly patients with stable schizophrenia[J]. Shanghai Nursing, 2023, 23(8): 53-56. https://www.cnki.com.cn/Article/CJFDTOTAL-SHHL202308012.htm