Thorup A, Petersen L, Jeppesen P, Ohlenschlaeger J, Christensen T, Krarup G, Jørgensen P, Nordentoft M
Bispebjerg Hospital, Dept. Psychiatry, Bispebjerg Bakke 23, DK 2400 Copenhagen NV, Denmark.
Schizophr Res. 2005 Nov 1;79(1):95-105. doi: 10.1016/j.schres.2004.12.020.
To investigate the effect of integrated treatment on negative, psychotic and disorganised symptoms in patients with first episode psychosis.
A RCT comparing integrated treatment (IT) with standard treatment (ST) was conducted, including 547 patients, aged 18-45, diagnosed with schizophrenia spectrum disorders. All patients were assessed with SCAN, SAPS and SANS at entry and after 1 and 2 years. The IT consisted of assertive community treatment, multifamily groups, psycho-education and social skills training, and the caseload was 1:10 compared with 1:25 in ST. Since attrition was considerable, a mixed model analysis with repeated measurements was used to examine the possible effects of IT statistically.
IT reduced both negative and positive symptoms significantly better than ST. Most marked were the results from the negative dimension, where all five global scores from SANS had a significantly better reduction in IT. Sub-analyses did not single out any one element in the integrated treatment that could explain this result.
Integrated treatment significantly reduced both negative and psychotic symptoms, assumably due to the different psychosocial treatment elements that were provided in the IT. The results indicate that the integrated approach is crucial, since, most likely, many aspects of the integrated treatment have contributed to the reduction of symptoms.
探讨综合治疗对首发精神病患者阴性、精神病性及紊乱症状的影响。
进行一项随机对照试验，比较综合治疗（IT）与标准治疗（ST），纳入547例年龄在18 - 45岁、诊断为精神分裂症谱系障碍的患者。所有患者在入组时、1年和2年后均接受了SCAN、SAPS和SANS评估。综合治疗包括积极社区治疗、多家庭团体治疗、心理教育和社交技能训练，其个案管理比例为1:10，而标准治疗为1:25。由于失访情况较为严重，采用重复测量的混合模型分析来统计学检验综合治疗的可能效果。
综合治疗在减轻阴性和阳性症状方面均显著优于标准治疗。在阴性维度上结果最为显著，SANS的所有五个总体评分在综合治疗组中的降低幅度均显著更好。亚分析未明确指出综合治疗中的任何一个要素可以解释这一结果。
综合治疗显著减轻了阴性和精神病性症状，推测这是由于综合治疗中提供的不同心理社会治疗要素所致。结果表明综合方法至关重要，因为很可能综合治疗的许多方面都对症状减轻起到了作用。
