Kamiński R
Katedry i Kliniki Psychiatrii Pomorskiej Akademii Medycznej w Szczecinie, ul. Broniewskiego 26, 71-460 Szczecin.
Ann Acad Med Stetin. 2001;47:177-88.
Psychotherapy remains the most efficient form of treatment in neurotic and personality disorders. It is a process whereby the therapist can influence and change the patient's personality. As a result, patients are able to better understand their experiences and behavior and are given a chance to be freed from symptoms. The goal of the present study was to establish the relationship between group psychotherapy and specific symptom clusters, and to follow changes in the personality structure of patients of both genders diagnosed according to ICD-10 classification. The Symptoms Questionnaire and the Personality Factor test were used to determine the severity of symptoms and study personality traits. The study group consisted of 115 patients (76 women and 39 men) with neurotic or personality disorders, participating in group therapy at the Day Care Unit of the Department of Psychiatry, Pomeranian Academy of Medicine in Szczecin between 1992 and 1998. Four groups were formed depending on the diagnosis according to ICD-10 classification: anxiety disorders--F41; somatic disorders--F45; neurotic disorders--F48; and personality disorders--F60 (Table 1). Treatment started and ended with a CV Questionnaire, Symptoms Questionnaire and Personality Factor test. Group psychotherapy was in the open form and the duration of treatment was 12 weeks with 2 sessions per day. In order to detect any improvement in mental health and symptoms, patients were given the Symptoms Questionnaire on a weekly basis. Statistics were done with the SPSS software package. It was found that the global intensity of symptoms before treatment was highest in patients with somatic form of the disorder. In this group after therapy, the intensity of symptoms was lowest, probably because of conversion of primary to secondary anxiety. A considerable decrease in the intensity of symptoms may also be explained by stronger motivation of these patients to benefit from therapy because of their severe symptoms. A link between the clinical diagnosis according to ICD-10 and some symptoms reported by the patients was noted. Thus, the Symptoms Questionnaire could be a useful tool precisely revealing specific symptoms in some disorders. No statistically significant differences on the Symptoms Questionnaire scale based on ICD-10, nor any differences in personality traits were found. The personality traits were different for men and women before and after therapy. As for hysterical symptoms, improvement was greater in women. After psychotherapy, the structure of personality traits improved in both sexes (Fig. 1). An essential alleviation of symptoms was found at the beginning and at the end of treatment (Table 2). The main conclusions are: 1. Group psychotherapy is an efficient method of treatment for patients who suffer from anxiety-related disorders. 2. The Symptoms Questionnaire and Personality Factor test were very useful for assessing the results of psychotherapy. 3. Alleviation of symptoms during treatment differed between men and women in 3 out of 13 symptom clusters and no significant differences between disorders according to ICD-10 were found. Consequently, these criteria are of little value for preliminary evaluation of therapeutic success. 4. Alleviation of symptoms was observed at the beginning and end of treatment. Symptom severity remained constant in the middle part of treatment.
心理治疗仍然是神经症和人格障碍最有效的治疗形式。它是一个过程,通过这个过程治疗师能够影响并改变患者的人格。结果,患者能够更好地理解自己的经历和行为,并有机会摆脱症状。本研究的目的是确定团体心理治疗与特定症状群之间的关系,并追踪根据国际疾病分类第十版(ICD - 10)分类诊断的男女患者人格结构的变化。使用症状问卷和人格因素测试来确定症状的严重程度并研究人格特质。研究组由115名患有神经症或人格障碍的患者组成(76名女性和39名男性),他们于1992年至1998年期间在什切青波美拉尼亚医学院精神病学系日间护理单元参加团体治疗。根据ICD - 10分类的诊断形成了四组:焦虑症——F41;躯体形式障碍——F45;神经症——F48;人格障碍——F60(表1)。治疗开始和结束时都进行了履历问卷、症状问卷和人格因素测试。团体心理治疗采用开放式,治疗持续12周,每天进行2次治疗。为了检测心理健康和症状的任何改善情况,每周给患者发放症状问卷。使用SPSS软件包进行统计分析。结果发现,在患有躯体形式障碍的患者中,治疗前症状的总体强度最高。在该组治疗后,症状强度最低,这可能是因为原发性焦虑转变为继发性焦虑。这些患者症状强度的显著降低也可以用他们因症状严重而从治疗中获益的更强动机来解释。注意到根据ICD - 10的临床诊断与患者报告的一些症状之间存在联系。因此,症状问卷可能是准确揭示某些疾病特定症状的有用工具。在基于ICD - 10的症状问卷量表上未发现统计学上的显著差异,在人格特质方面也未发现任何差异。治疗前后男性和女性的人格特质不同。至于癔症症状,女性的改善更大。心理治疗后,男女两性的人格特质结构都有所改善(图1)。在治疗开始和结束时发现症状有显著缓解(表2)。主要结论如下:1. 团体心理治疗是治疗焦虑相关障碍患者的有效方法。2. 症状问卷和人格因素测试对评估心理治疗结果非常有用。3. 在13个症状群中的3个症状群中,治疗期间症状缓解在男性和女性之间存在差异,并且根据ICD - 10的疾病之间未发现显著差异。因此,这些标准对治疗成功的初步评估价值不大。4. 在治疗开始和结束时观察到症状缓解。治疗中期症状严重程度保持不变。