Swanson A J, Pantalon M V, Cohen K R
Department of Psychiatry, St. Barnabas Hospital, Bronx, New York 10457, USA.
J Nerv Ment Dis. 1999 Oct;187(10):630-5. doi: 10.1097/00005053-199910000-00007.
The effect of motivational interviewing on outpatient treatment adherence among psychiatric and dually diagnosed inpatients was investigated. Subjects were 121 psychiatric inpatients, 93 (77%) of whom had concomitant substance abuse/dependence disorders, who were randomly assigned to: a) standard treatment (ST), including pharmacotherapy, individual and group psychotherapy, activities therapy, milieu treatment, and discharge planning; or b) ST plus motivational interviewing (ST+MI), which involved 15 minutes of feedback on the results of a motivational assessment early in the hospitalization, and a 1-hour motivational interview just before discharge. Interviewers utilized motivational techniques described in Miller and Rollnick (1991), such as reflective listening, discussion of treatment obstacles, and elicitation of motivational statements. Results indicated that the proportion of patients who attended their first outpatient appointment was significantly higher for the ST+MI group (47%) than for the ST group (21%; chi2 = 8.87, df = 1, p<.01) overall, and for dually diagnosed patients (42% for ST+MI vs. 16% for ST only; chi2 = 7.68, df = 1, p<.01). Therefore, brief motivational interventions show promise in improving outpatient treatment adherence among psychiatric and dually diagnosed patients.
研究了动机性访谈对精神科住院患者及同时患有精神疾病和物质使用障碍的住院患者门诊治疗依从性的影响。研究对象为121名精神科住院患者，其中93名（77%）同时患有物质滥用/依赖障碍，这些患者被随机分为：a）标准治疗（ST）组，包括药物治疗、个体和团体心理治疗、活动治疗、环境治疗及出院计划；或b）标准治疗加动机性访谈（ST+MI）组，即在住院早期对动机评估结果进行15分钟的反馈，并在出院前进行1小时的动机性访谈。访谈者采用了Miller和Rollnick（1991）中描述的动机性技巧，如反思性倾听、讨论治疗障碍以及引出动机性陈述。结果表明，总体而言，ST+MI组（47%）首次门诊预约就诊患者的比例显著高于ST组（21%；卡方检验=8.87，自由度=1，p<0.01），对于同时患有精神疾病和物质使用障碍的患者也是如此（ST+MI组为42%，仅ST组为16%；卡方检验=7.68，自由度=1，p<0.01）。因此，简短的动机性干预在提高精神科及同时患有精神疾病和物质使用障碍患者的门诊治疗依从性方面显示出前景。
