早期干预对首发精神分裂症预后的影响

目的：了解早期干预对首发精神分裂症复发的影响。方法：对30例首发精神分裂症患者，病期在3个月以内知的，在住院期间配合积极家庭干预及出院后继续干预（干预组）并与30例首发精神分裂症患者，病期在3个月以上治疗条件相仿，无家庭干预（对照组）进行对照。对两组的复发率进行比较。结果：干预组疗效明显好于对照组，干预组复发率明显少于对照组（P＜0.05）。结论：积极的家庭干预能促进服药的依从性，减少复发率，促进康复。     

免费投药对精神分裂症疗效的一年随访研究

目的评估免费投放抗精神病药对精神分裂症患者的疗效。方法对100例非急性期精神分裂症患者配对后按随机数字表随机分为2组,免费投放组48例和对照组52例。免费投放组由医生定时上门免费发药并巡诊,对照组自行选择普通门诊治疗,随访1年。采用简明精神病评定量表（BPRS）和社会功能缺陷筛选量表（SDSS）评估,同时监测复发、再住院、就业及服药依从情况。结果随访结束时免费投放组BPRS,SDSS评分,复发率、再住院率、就业率均显著优于对照组（P〈0.05）,而且服药依从性更好（P〈0.01）。结论免费投放抗精神病药对精神分裂症患者的疗效优于普通门诊,能减少复发,提高患者的依从性,改善患者的社会功能。     

系统康复治疗对慢性精神分裂症患者的随访研究

目的探讨系统康复治疗对慢性精神分裂症患者的康复效果。方法将80例慢性精神分裂症患者按入院顺序分为康复组和对照组,每组40例。在常规住院治疗的基础上单独对康复组病人施以为期3个月的系统康复治疗,用BPRS、自知力与治疗态度问卷（ITAQ）和社会功能缺陷筛选量表（SDSS）于入组时、出院时和出院后1a对患者进行相关评定。结果出院时2组BPRS、SDSS、ITAQ总分均较入组时有明显改善,康复组较为明显（P〈0.05或P〈0.01）;并维持至出院1a仍显著优于对照组（P〈0.05）;且1a内的复发率和再住院率显著低于对照组（P〈0.05）。结论系统康复治疗可提高慢性精神分裂症患者的治疗依从性,改善患者的精神症状,降低复发率和再住院率,有益于患者社会功能恢复。     

居家护理干预对精神分裂症患者长期预后的影响

目的探讨居家护理在精神分裂症患者康复中的干预作用。方法选择痊愈精神分裂症120例,随机分为干预组60例和对照组60例,出院后两组均给予精神药物治疗。干预组实施出院后居家护理康复指导,包括定期电话和上门随访。对照组实施常规出院宣教,每个月门诊复查和电话咨询。在出院时及第6、12个月末两组分别采用日常生活能力（ADL）评定量表、简明精神病评定量表（BPRS）及康复状态量表（MRSS）、进行评定,并统计1年内复发情况。结果观察1年后,干预组的ADL总分、BPRS总分、MRSS总分低于对照组,差异有显著性意义（P〈0.01）;干预组服药依从性高于对照组,差异有显著性意义（P〈0.01）,干预组的复发率（21.67%）低于对照组（33.39%）,差异有显著性意义（P〈0.05）。结论实施居家护理干预可巩固治疗效果,减少疾病复发,改善日常生活能力。     

利用网络防治精神分裂症复发对照研究

目的：探讨网络对非急性期精神分裂症患者的作用。方法：选取71例非急性期精神分裂症患者随机分为两组,数字化网络组（数字化网络配合社区防治网）35例,社区防治组36例（由社区防治网随访）。最后完成62例。在药物治疗的基础上,对数字化网络组患者进行网上心理咨询,社区防治组进行一般康复干预。随访1年。应用阳性与阴性症状量表（PANSS）、社会功能缺陷筛选量表（SDSS）进行评估,同时监测其复发率和药物依从性。结果：随访结束时PANSS各量表的评分数字化网络组均显著优于社区防治组（P〈0.01）。数字化网络组1年复发恶化率低于社区防治组（P〈0.05）。药物依从性和社会功能数字化网络组均显著优于社区防治组（P均〈0.01）。结论：在药物治疗的基础上,利用数字化网络配合社区防治网对精神分裂症患者预防复发,改善社会功能有明显作用。     

个体服务计划对农村社区精神分裂症患者康复的影响

目的:探讨个体服务计划(ISP)社区康复管理模式对农村精神分裂症患者康复的影响。方法:按随机数字表法将2个乡镇110例精神分裂症患者分为研究组和对照组各55例,并分别实施ISP社区康复管理模式或现行的社区管理模式6个月。患者入组时、入组后3及6个月给予自知力与治疗态度问卷(ITAQ)、服药依从性量表评定;比较1年后两组的复发率。结果:干预前两组患者ITAQ总分、治疗依从性比较差异均无统计学意义;干预后3及6个月时两组ITAQ总分较基线显著提高(P均0.01);且研究组ITAQ评分及服药依从性明显高于对照组(P均0.01);随访1年研究组复发率(24.53%)显著低于对照组(43.14%)(P0.05)。结论:ISP社区康复管理模式对改善农村精神分裂症患者的自知力、提高治疗依从性、降低复发率有一定的作用。     

家庭化住院对精神分裂症患者疗效随访研究

目的：探讨模拟家庭环境住院治疗对首发精神分裂症患者的康复效果。方法：将92例首发精神分裂症患者随机分为家庭化组和对照组各46例,均以氯氮平治疗,家庭化组采用模拟家庭环境住院治疗,对照组采用封闭式住院治疗。疗程8周。分别于治疗前及治疗8周进行阳性与阴性症状量表（PANSS）、自知力与治疗态度问卷（ITAQ）及服药依从性评定。对疗效达显著进步及以上的患者进行为期1年随访,结果：PANSS评分两组差异无显著性。治疗前ITAQ评分及服药依从性两组相仿;治疗8周后家庭化组均明显高于对照组。随访1年后,家庭化组复发率明显低于对照组。结论：模拟家庭环境住院治疗不仅有助于首发精神分裂症患者的治疗,而且可降低其复发率。     

认知行为干预对首发精神分裂症康复效果的追踪调查研究

目的 探讨认知行为干预首发精神分裂症患者的康复作用.方法 将我院精神科首发精神分裂症住院患者80例随机分为两组（研究组与对照组各40例）,两组患者均采用常规药物治疗和精神科护理,研究组患者住院两周后增加认知行为干预,康复出院回归社区后每月组织患者集中授课、放松1次,持续2年.采用生活质量综合评定问卷-74（GQOLI-74）、自知力及治疗态度问卷（ITAQ）、治疗依从性及复发率进行评价.结果 回归社区2年后,研究组GQOLI-74量表躯体功能、心理功能、社会功能及总体生活质量评分均显著高于对照组（P＜0.01）.回归社区2年后,研究组患者自知力明显优于对照组（P＜0.05）;回归社区1、2年后,研究组患者治疗依从性明显优于对照组（P＜0.05,P＜0.01）;回归社区2年后,研究组患者复发率显著低于对照组（P＜0.01）.结论 认知行为干预可提高精神分裂症患者的自知力、服药依从性和生活质量,降低复发率.     

内观心理疗法对慢性精神分裂症患者社会人际关系、社会功能及生活质量的影响

目的探讨内观心理疗法对慢性精神分裂症患者社会人际关系、社会功能及生活质量的影响。方法选取2013年2月~2015年6月我院收治的120例慢性精神分裂症患者为研究对象,随机数字表法均分为研究组和对照组,对照组给予抗精神病药物治疗,研究组在对照组基础上加用内观心理疗法,治疗后评估两组社会人际关系、社会功能及生活质量并进行比较,同时随访两组患者治疗后1年复发情况。结果治疗前两组社会人际关系、社会功能及生活质量评估指标相较均无统计学意义(P0.05),治疗后研究组人际关系敏感因子、敌对因子评分及社会人际关系各因子得分分别均较治疗前显著降低(P0.05);治疗后1个月、2个月、3个月研究组住院精神患者社会功能评定量表(Social-Skills for Psychiatric Inpatients,SSPI)总评分均显著高于对照组(P0.05);研究组躯体健康、心理健康、社会功能评分均显著高于对照组(P0.05);研究组治疗后1年复发率(3.33%)及再住院率(1.67%)均显著低于对照组(复发率20.00%,再住院率11.67%)(P0.05)。结论内观心理疗法可显著改善慢性精神分裂症患者社会人际关系、社会功能及生活质量,有效降低复发率及再住院率,在临床中有较广泛的应用价值。     

社区综合干预对慢性精神分裂症患者生活质量的影响

目的：探讨社区综合干预对慢性精神分裂症患者生活质量和服药依从性的影响。方法：120例慢性精神分裂症患者,随机分成研究组和对照组,各60例。研究组进行社区综合干预,对照组只进行药物治疗。入组前后实施简明精神病评定量表（BPRS）、生活质量综合评定问卷74（GQOLI-74）以及自知力与治疗态度问卷（ITAQ）评定。结果：治疗12个月研究组BPRS评分显著低于对照组（P〈0．05）;研究组GQOLI-74心理健康因子评分和社会功能因子评分显著高于对照组（P〈0．05）;研究组ITAQ评分显著高于对照组（P〈0．05）。结论：社区综合干预能改善慢性精神分裂症患者的生活质量,提高服药依从性。     

内观疗法与行为疗法对精神分裂症患者近期服药依从性的影响

目的:探讨内观疗法和行为疗法对精神分裂症患者近期服药依从性的影响。方法:161例住院的精神分裂症患者随机分为内观+行为组(39例,住院时内观治疗,出院后行为治疗)、内观组(41例,住院时内观治疗)、行为组(37例,出院后行为治疗)及对照组(44例,无内观及行为治疗);用药片计数法比较各组患者出院后12周服药依从性。结果:12周后服药完全依从、部分依从和不依从内观+行为组分别为32例、4例、3例,内观组为18例、11例、12例,行为组为16例、12例、9例,对照组为6例、13例、25例;各组间差异有统计学意义(χ2=43.50,P0.0001);服药完全依从率内观+行为组明显高于其他3组,内观组及行为组明显高于对照组(P均0.01)。结论:内观疗法和行为疗法均能提高患者的近期服药依从性,两者结合效果更佳。     

Naikan therapy for prolonged depression: psychological changes and long-term efficacy of intensive Naikan therapy]

OBJECTIVE: Many studies have shown that a considerable number of patients with prolonged depression are refractory to drug therapy or supportive psychotherapy. A few studies have shown the short-term effectiveness of intensive Naikan therapy for prolonged depression, but the long-term effects have not been reported. For other psychotherapies also, few studies have demonstrated their long-term effectiveness for prolonged depression. The purpose of the present study was to assess the long-term efficacy of intensive Naikan therapy for patients with prolonged depression and to investigate the factors contributing to its efficacy. METHOD: At Tottori University Hospital, 23 inpatients with prolonged depression were treated with intensive Naikan therapy. The age, sex, age at onset, number of depressive episodes, duration of the present episode, diagnosis and family history were investigated. The Tokyo University Egogram (TEG), Yatabe-Guiltora personality inventory (YG test) and Rosenzweig picture-frustration (PF) study were conducted before and after intensive Naikan therapy to investigate psychological changes. The long-term efficacy (average: 24.5 +/- 10.6 months) of intensive Naikan therapy for prolonged depression was assessed with Global Assessment of Functioning scale (GAF). "Improvement" was defined as a post-therapy GAF score of 61 or higher. The Hamilton Depression Rating Scale (HAM-D) was applied to confirm the GAF results. Whether the patient achieved awareness of other's viewpoint, awareness of egocentricity, feeling of love, breaking out from self and sense of fulfillment after intensive Naikan therapy was investigated. RESULTS: Fifteen patients (65.2%) showed improvement in GAF and HAM-D (improved group) and eight patients showed no improvement (non-improved group). The average GAF score changed from 46.1 (before Naikan therapy) to 81.8 (at outcome assessment) in the improved group and from 45.3 to 52.8 in the non-improved group. The improved group had significantly shorter average duration of the present depressive episode and significantly less depressive episodes compared to the non-improved group. Only the improved group showed significantly lower scores on the critical parent (CP) scale of TEG, cyclic tendency (C) on the YG test and extraggression (E-A) in PF study. In the improved group, significantly more patients achieved deep insight (Naikan); and significantly more patients achieved awareness of other's viewpoint, awareness of egocentricity, feeling of love, breaking out from self and sense of fulfillment after intensive Naikan therapy. CONCLUSIONS: Our results suggested that intensive Naikan therapy for prolonged depression was equally as effective as Morita therapy, interpersonal therapy or group psychotherapy, and the effects of intensive Naikan therapy continued for a long term. Attainment of deep Naikan brought psychological changes in patients showing improvement, motivating them to continue Naikan therapy in daily life. We consider that this is the key factor that maintains the long-term efficacy of intensive Naikan therapy.     

Does daily Naikan therapy maintain the efficacy of intensive Naikan therapy against depression?

Aim:  Naikan Therapy, which has been applied to treating patients with various mental difficulties, can be classified into two major categories: intensive Naikan therapy, which lasts for seven days in a Naikan center or a clinical institute secluded from the outside world for the purpose of deep introspection, and daily Naikan therapy, which can be integrated into regular daily activities. The aim of this research is to evaluate daily Naikan therapy as a maintenance treatment for depression.
Methods:  Forty-seven patients, who were diagnosed as having major depressive disorder using DSM-IV criteria and who practiced intensive Naikan therapy participated in the present study. Two groups of patients were compared: 24 patients who conducted daily Naikan therapy and 23 patients who did not, after practicing intensive Naikan therapy. To evaluate efficacy, the Beck Depression Inventory was used as a primary outcome measure for the assessment of depression. The State–Trait Anxiety Inventory and the Cornell Medical Index were also used as secondary outcome measures to evaluate anxiety and psychosomatic conditions before, immediately after and three months after intensive Naikan therapy.
Results:  Significant between-group differences were obtained in the time course change of depression, anxiety and psychosomatic scores within three months following the completion of intensive Naikan therapy.
Conclusion:  The current study indicates that conducting daily Naikan therapy is effective for maintaining the psychological and psychosomatic state at 3 months following the intensive Naikan therapy, while a lack of therapy may allow the patients to exacerbate their conditions to the level they held before practicing intensive Naikan therapy.     

运用知情同意干预改善精神分裂症康复期患者的治疗依从性

目的　探索知情同意干预能否提高病人的治疗依从性。方法　选择部分住院精神分裂症康复期病人 12 0例 ,随机分为对照组和研究组各 6 0例 ,男、女各 6 0例 ,研究组病人除进行常规治疗和护理外 ,在康复期过程中再接受知情同意干预。评定工具为自行设计知情同意问卷及病人治疗依从性问卷各 1份 ,经信度、效度测定r>0 .77。结果　研究组病人经知情同意干预后 ,治疗依从性明显优于对照组。三项内容 (治疗、检查、护理依从性 )均有显著性差异 (P <0 .0 5 )。结论　知情同意干预能提高病人治疗依从性 ,从而促进病人的康复 ,对预防复发也具有很重要的意义。     

内观疗法对青少年抑郁症患者的疗效观察

目的 探讨内观疗法对青少年抑郁症患者疗效的影响.方法 86例青少年抑郁症患者随机分为研究组（43例）和对照组（43例）,研究组患者给予疗程为5d的内观治疗联合28 d的舍曲林治疗,对照组患者给予4周的舍曲林治疗,治疗前后采用汉密尔顿抑郁量表（HAMD-17）和社会适应能力诊断量表对两组患者进行疗效评定.结果 治疗5d、28 d后两组HAMD-17评分均较治疗前显著降低（P＜0.01）,研究组HAMD-17评分低于对照组（P＜0.01）.治疗28 d后两组HAMD-17评分均较同组治疗5d后评分降低（P＜0.01）.治疗5d、28 d后两组社会适应量表评分均较治疗前升高（P＜0.01）,研究组社会适应量表评分高于对照组（P＜0.01）.治疗28 d后两组社会适应量表评分均较同组治疗5d后评分升高（P＜0.01）.结论 内观疗法联合抗抑郁药物能有效改善青少年抑郁症患者的抑郁情绪,并提高其社会适应能力.     

The application of Naikan therapy in China]

PURPOSE: To briefly introduce the application of Naikan therapy in China. METHOD: Naikan therapy of one-day-type was adapted towards 1,226 out-patients of neurasthenia diagnosed according to ICD-10, with a neurotic factor higher than norm obtained by means of Eyesenck personality questionnaire (Chinese version of EPQ-RSC). For each visit, the one-day-type Naikan therapy would need 8 hours, with a noon break of an hour for lunch. At the final hour of each visit, the patient would say their own thought to the therapist and receive advice. The therapy for a common case would need 1 visit to 5 visits, with a week between two consecutive visits. For a few cases, 10 visits were needed. RESULT: The mood of the patients was obviously improved through Naikan therapy. Among the 248 out-patients with a relatively complete personal data and a L-score lower than norm, 111 out-patients (44.76%) with a N-score higher than norm before therapy, 40 out-patients (16.13%) with a N-score higher than norm post therapy. CONCLUSION: The Naikan therapy showed its effectiveness in improving the neurotic factor as well as mood of the patients.     

The present state of Naikan in Japan]

I. Questionnaires concerning the state of propagation of Naikan therapy: comparison between 1984 and 2002 (1) OBJECTIVE: I maintained that Naikan will be difficult to introduce unless it is known to and recognized by many researchers and therapists at the symposium titled "How Naikan should be introduced" in the 7th Conference of the Japanese Naikan Society in 1984 and carried out a questionnaire survey about how much knowledge about Naikan the respondents had, whether they had experienced Naikan or not, and whether they were willing to practice Naikan or not in April, 1984. This year, 18 years after the initial survey, I conducted a questionnaire survey with the same contents in similar subjects to evaluate whether Naikan had become more accepted and better known since the previous survey. (2) SUBJECTS: Since I thought that the attitudes of young assistant professors have the greatest effect on future trends of psychiatry, 80 assistant professors at psychiatric departments of medical schools of universities and medical colleges throughout Japan were selected as subjects. In the present survey, 80 professors were also included as subjects. Also, 3 hospitals were randomly selected in each prefecture from medium-sized private psychiatric hospitals with 200-300 beds, a size considered to be appropriate for practicing Naikan therapy, and the directors of the total of 141 hospitals were included in the subjects. II. RESULT AND SUMMARY (1) The response rate increased slightly in the assistant professors, more than doubled in the hospital directors, and was highest in the professors (67.5%). (2) Knowledge about Naikan therapy had scarcely spread among assistant professors since the previous survey. However, it markedly spread among hospital directors, and 37.6% of the hospital directors surveyed, a nearly 4-fold increase compared with the previous survey, were relatively well informed about Naikan. About half (46.4%) of the professors had considerable knowledge about Naikan. (3) Most of the assistant professors had little experience in the practice of Naikan therapy, but 28.9% of the hospital directors, more than double the percentage of the previous survey, had practiced or used Naikan. Few professors practiced it. (4) About whether the respondents are willing to practice Naikan in the future or not, a greater percentage of the assistant professors had no intention to practice it in the future, and the percentage of hospital directors who had no intention to practice it also increased while the percentage of those who wanted to practice it in the future increased simultaneously, showing polarization of the attitude. Of the professors, 53.7% hoped to practice it, but its realization was difficult due to the lack of cooperation by the staff and the restriction of time. (5) Factors that prevented spread of Naikan therapy were: [1] Young assistant professors were so preoccupied with their specialties that they took little interest in other fields, [2] research subjects of assistant professors are recently titled markedly to biological fields, [3] Naikan therapy is difficult to be accepted by young researchers because of the immaturity of its theorization, impreciseness of its indications, and the difficulty of evaluation of its therapeutic effects with the resultant ambiguity of the results, [4] it is difficult to gain support from hospital directors, because it is not covered by insurance policies so that its practice produces a large economic burden, because the place for its daily practice is difficult to secure, and because it requires a long time each day to both the patients and instructors. I hope that these factors that prevent propagation of Naikan are eliminated one by one and that it comes to be practiced worldwide to relieve many people of mental and physical ailments.     

内观疗法对精神分裂症患者社会功能的影响

目的：评估内观治疗对精神分裂症患者社会功能恢复的疗效。方法：21例精神分裂症患者原有抗精神病药治疗不变增加内观治疗。治疗前后以社会功能缺陷筛选量表（SDSS）、阳性和阴性症状量表（PANSS）、临床疗效总评量表（CGI）;社会支持评定量表（SSRS）;生活满意度评定量表（LSR）评估。结果：治疗后PANSS、CGI、SDSS均有显著性改善。结论：内观治疗对精神分裂症患者人际关系的处理和改善阴性症状促进社会功能恢复有明显疗效。     

改良型内观疗法联合药物治疗青少年焦虑症的疗效

目的 探讨改良型内观疗法联合药物治疗青少年焦虑症的疗效.方法 将61例中山市人民医院心理门诊就诊的青少年焦虑症患者随机分为研究组(32例)和对照组(29例),研究组给予舍曲林联合改良型内观疗法治疗,对照组采用舍曲林及一般心理疏导治疗,所有患者均于治疗前、治疗后1周、4周和8周采用汉密尔顿焦虑量表(HAMA)、焦虑自评量表(SAS)和社会适应能力量表进行疗效评定.结果 两组患者的HAMA及SAS治疗后1周、4周和8周的评分均低于治疗前,差异有统计学意义(P<0.05);两组间比较,研究组治疗后1周、4周末和8周的HAMA和SAS评分均低于对照组,差异有统计学意义(P<0.05).两组患者的社会适应能力量表治疗后1周、4周和8周的评分均较治疗前升高,差异有统计学意义(P<0.05);两组间比较,研究组治疗后1周、4周和8周的评分均高于对照组,差异有统计学意义(P<0.05).结论 改良型内观疗法联合药物治疗对改善青少年焦虑障碍有明显疗效.     

Single-blind,randomized controlled trial of effectiveness of Naikan therapy as an adjunctive treatment for schizophrenia over a one-year follow-up period

Background

Current treatments for schizophrenia are often only partially effective.

Aims

Assess the possible benefit of using adjunctive Naikan therapy, a cognitive approach based on self-reflection that originated in Japan for the treatment of schizophrenia.

Methods

After resolution of acute psychotic symptoms, 235 psychiatric inpatients with schizophrenia who had a middle school education or higher were randomly assigned to a control group (n=112) that received routine medication and inpatient rehabilitative treatment or an intervention group (n=123) that also received adjunctive Naikan therapy for 2 hours daily, 5 days a week for 4 weeks. The patients were then discharged and followed up for 12 months. The Positive and Negative Syndrome Scale (PANSS), Personal and Social Performance scale (PSP), and Insight and Attitude Questionnaire (ITAQ) were used to assess patients at enrollment, after the 1-month intervention, and after the 12-month follow-up. Evaluators were blind to the group assignment of patients.

Results

Only 13 (10.6%) of the intervention group participants relapsed over the 12-month follow-up, but 23 (20.5%) control group participants relapsed (X²=4.50, p=0.034). Using a modified intention-to-treat analysis and a repeated measure analysis of variance, the PANSS, PSP, and ITAQ total scores all showed significantly greater improvement over the 12-month follow-up in the Naikan group than in the control group. The drop in mean chlorpromazine-equivalent dosage from enrollment to the end of follow-up was significantly different in the intervention group but not in the control group, though the change in dosage over time between groups was not statistically significant.

Conclusions

This study provides robust support for the effectiveness of Naikan therapy as an adjunctive treatment during the recovery period of schizophrenia. Compared to treatment as usually, adjunctive Naikan therapy can sustain the improvement in psychotic symptoms achieved during acute treatment, improve insight about the illness, enhance social functioning, and reduce relapse over a one-year follow-up period. Further research of this treatment with larger and more diverse samples of patients with schizophrenia is merited.