Buchain Patrícia Cardoso, Vizzotto Adriana Dias Barbosa, Henna Neto Jorge, Elkis Helio
Schizophrenia Program and Proerta (Projesq). Treatment Resistant Schizophrenia Project. Institute of Psychiatry of the Hospital das Clínicas of the School of Medicine-University of São Paulo (FMUSP). São Paulo, SP, Brazil.
Braz J Psychiatry. 2003 Mar;25(1):26-30. doi: 10.1590/s1516-44462003000100006.
It is well established that the combination of psychopharmacological treatment and psychosocial interventions, such as psychotherapy, family orientation and occupational therapy (OT), represent the best strategy for treating patients with schizophrenia. However, in terms of treatment-resistant schizophrenia (TRS) almost only psychopharmacological treatments are available and psychosocial interventions such as OT had not proved to be effective. The aim of this study is to investigate if OT is effective when added to a psychopharmacological treatment in TRS.
Two groups of patients with TRS were compared: The experimental group (EG) received psychopharmacological treatment with clozapine plus sessions of occupational therapy (OT) and the control group (CG) received only clozapine. The Scale for Interactive Observation in Occupational Therapy (EOITO) was employed to evaluate the outcome. The duration of the study was 6 months and patients were rated at baseline and monthly totaling 7 assessments. EOITO was independently applied by two occupational therapists with high reliability rates (Kappa=0.90, p=0.001). Repeated measures of analyses of variance and the evaluation of the standardized effect sizes were used for statistical analyses.
The EG showed that the OT intervention was effective along the whole period of observation, mainly from the 4th month to the end of the study.
In patients with TRS the combination of OT and clozapine showed to be more effective than the use of clozapine alone. OT may represent an additional therapeutic option for patients with TRS.
众所周知，心理药物治疗与心理社会干预措施相结合，如心理治疗、家庭导向治疗和职业治疗（OT），是治疗精神分裂症患者的最佳策略。然而，对于难治性精神分裂症（TRS），几乎只有心理药物治疗可用，而诸如职业治疗等心理社会干预措施尚未被证明有效。本研究的目的是调查在TRS患者中，职业治疗加心理药物治疗是否有效。
对两组TRS患者进行比较：实验组（EG）接受氯氮平心理药物治疗加职业治疗（OT）疗程，对照组（CG）仅接受氯氮平治疗。采用职业治疗互动观察量表（EOITO）评估结果。研究持续时间为6个月，患者在基线时以及每月进行一次评估，共进行7次评估。EOITO由两名职业治疗师独立应用，信度率很高（kappa = 0.90，p = 0.001）。采用重复测量方差分析和标准化效应量评估进行统计分析。
实验组表明，职业治疗干预在整个观察期内均有效，主要是从第4个月到研究结束。
在TRS患者中，职业治疗与氯氮平联合使用比单独使用氯氮平更有效。职业治疗可能是TRS患者的一种额外治疗选择。
