Peer Jason E, Spaulding William D
Department of Psychology, University of Nebraska-Lincoln, United States.
Schizophr Res. 2007 Jul;93(1-3):186-93. doi: 10.1016/j.schres.2007.03.002. Epub 2007 Apr 19.
Research in schizophrenia and related severe mental illness (SMI) suggests that psychiatric rehabilitation facilitates recovery of psychosocial functioning although there is considerable heterogeneity in outcomes. The present study used growth mixture modeling (GMM), a longitudinal latent variable modeling strategy, to identify classes of psychosocial functioning recovery trajectories. Archival clinical assessment data representing the first 18 months of an inpatient psychiatric rehabilitation program were analyzed from a sample of participants with schizophrenia spectrum disorders (N=162). Based on a GMM analysis of monthly Nurse Observation Scale for Inpatient Evaluation (NOSIE) scores two classes were identified that differed in overall level of psychosocial functioning, rate and nonlinear shape of change. The identified lower functioning group was characterized by poorer neurocognitive functioning at admission, a history of negative symptoms, more previous inpatient psychiatric days, and a longer length of stay in the rehabilitation program. However, this group showed significantly greater positive change in the NOSIE domains directly targeted by behavioral treatment: daily schedule competence, neatness, and irritability. Methodological and theoretical implications of these modeling strategies are discussed in the context of understanding the rehabilitation process.
对精神分裂症及相关严重精神疾病（SMI）的研究表明，尽管结果存在相当大的异质性，但精神科康复有助于心理社会功能的恢复。本研究使用生长混合模型（GMM）这一纵向潜变量建模策略，来识别心理社会功能恢复轨迹的类别。从一组精神分裂症谱系障碍参与者（N = 162）的样本中，分析了代表住院精神科康复项目前18个月的档案临床评估数据。基于对每月住院患者评估护士观察量表（NOSIE）得分的GMM分析，识别出了两类在心理社会功能总体水平、变化速率和非线性形状方面存在差异的类别。所识别出的功能较低组的特征是入院时神经认知功能较差、有阴性症状史、之前有更多的住院精神科天数以及在康复项目中的住院时间更长。然而，该组在行为治疗直接针对的NOSIE领域显示出显著更大的积极变化：日常安排能力、整洁度和易怒性。在理解康复过程的背景下，讨论了这些建模策略的方法学和理论意义。
