CCT与MSST联合分阶段干预对青少年精神分裂症病人认知功能的影响

目的探讨认知补偿训练(CCT)与药物自我管理技能训练(MSST)联合分阶段干预对青少年精神分裂症病人认知功能的影响。方法选取青少年精神分裂症病人59例为研究对象，随机分成观察组29例和对照组30例，对照组采取常规治疗干预，观察组采取MSST+CCT联合分阶段干预，比较2组干预前后认知功能、精神症状、服药依从性的变化。结果观察组认知策略练习依从性较差者7例(24.1%)，药物管理依从性较差者7例(24.1%)。病人住院时间与服药总天数呈明显正相关关系(r=0.493，P < 0.01)，服药总时间与CCT练习测量总时间呈正相关关系(r=0.379，P < 0.05)，CCT练习策略总次数与练习测量总时间呈正相关关系(r=0.450，P < 0.05)。干预前2组阳性与阴性症状量表(PANSS)总分和各分量表得分、认知功能测定(MMSE)总分、服药依从性总分比较差异均无统计学意义(P>0.05)。课程学习结束后, 观察组PANSS总分低于对照组(P < 0.05)，PANSS各分量表得分、MMSE总分、服药依从性总分差异均无统计学意义(P>0.05)。干预后3个月，观察组在PANSS总分和各分量表得分、MMSE总分、服药依从性总分上均优于对照组(P < 0.05~P < 0.01)。2组在干预前后各时间点各维度比较差异均有统计学意义(P < 0.05~P < 0.01)，观察组在课程结束后、干预3个月的PANSS总分、阳性症状得分上均较干预前降低(P < 0.05~P < 0.01)，对照组在干预3个月的PANSS总分、阳性症状得分上均较干预前和课程结束后有所降低(P < 0.01)；观察组干预后3个月在阴性症状上均较干预前和课程结束后降低(P < 0.01)，对照组干预后3个月在阴性症状上均较干预前降低(P < 0.01)；2组干预后3个月一般精神症状均较干预前和课程结束后降低(P < 0.05~P < 0.01)，MMSE总分均较干预前和课程结束后增加(P < 0.01)；2组在课程结束后、干预3个月的服药依从性得分均较干预前降低(P < 0.01)，观察组干预后3个月服药依从性得分较课程结束后仍降低(P < 0.01)。且观察组降低和增加幅度均高于对照组(P < 0.05~P < 0.01)。结论CCT与MSST联合干预的方式，可以更好地改善青少年精神分裂症的认知功能，精神病症状和用药依从性，值得临床推广应用。

Effects of CCT and MSST combined with staged intervention on cognitive function in adolescent patients with schizophrenia

ObjectiveTo explore the effects of compensatory cognitive training(CCT) and medication self-management skills training(MSST) combined with staged intervention on cognitive function in adolescent patients with schizophrenia.MethodsA total of 59 cases of adolescent schizophrenia patients were selected as research objects, who were randomly divided into observation group(n=29) and control group(n=30).The control group took routine treatment intervention, and the observation group took MSST+CCT combined staged intervention.The changes of cognitive function, mental symptoms and medication compliance before and after intervention were compared between the two groups.ResultsIn the observation group, 7 patients(24.1%) had poor compliance with cognitive strategy exercise, and 7 patients(24.1%) had poor compliance with drug management.The length of hospital stay was positively correlated with the total number of days of taking medication(r=0.493, P < 0.01).There was a positive correlation between the total number of days of taking medication and the total number of days of CCT practice measurement(r=0.379, P < 0.05).The total number of CCT practice strategies was positively correlated with the total number of practice measurement days(r=0.450, P < 0.05).Before intervention, there were no significant differences in the total score of positive and negative symptom scale(PANSS), total score of each subscale, total score of min-mental state examination(MMSE), and total score of medication compliance between the two groups(P < 0.05).After the course, the total score of PANSS in the observation group was lower than that in the control group(P < 0.05), there were no significant differences in PANSS subscales scores, MMSE total scores and medication compliance total scores(P < 0.05).Three months after intervention, the total scores of PANSS and its subscales, MMSE and medication compliance in the observation group were better than those in the control group(P < 0.05 to P < 0.01).There were statistically significant differences between the two groups at each time point before and after intervention(P < 0.05 to P < 0.01), the PANSS total positive symptom scores of the observation group at 3 months after intervention were lower than those before intervention(P < 0.05 to P < 0.01), PANSS total positive symptom scores of the control group at 3 months of intervention were lower than those before intervention and after the end of the course(P < 0.01);the negative symptoms in the observation group were lower 3 months after intervention than before and after the course(P < 0.01), the negative symptoms in the control group were lower than those before intervention 3 months after intervention(P < 0.01);general psychiatric symptoms in both groups were lower 3 months after intervention than before and after the course(P < 0.05 to P < 0.01), MMSE total scores increased compared with those before and after intervention(P < 0.01);the scores of medication compliance in both groups at 3 months after intervention were lower than those before intervention(P < 0.01), 3 months after intervention, the compliance score of the observation group continued to decrease compared with that after the course(P < 0.01), and the amplitude of decrease and increase in observation group was higher than that in control group(P < 0.05 to P < 0.01).ConclusionsThe combined intervention of CCT and MSST can better improve the cognitive function, psychotic symptoms and medication compliance of adolescent schizophrenia, which is worthy of clinical application.