用明尼苏达多相人格问卷评估的住院治疗中退出的厌食症患者的精神病理学特征。

Psychopathological features of anorectic patients who dropped out of inpatient treatment as assessed by the Minnesota multiphasic personality inventory.

机构信息

Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.

出版信息

Biopsychosoc Med. 2007 Jul 25;1:15. doi: 10.1186/1751-0759-1-15.

DOI:10.1186/1751-0759-1-15

PMID:17651492

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1971270/

Abstract

BACKGROUND

Anorexia nervosa often requires inpatient treatment that includes psychotherapeutic intervention in addition to physical and nutritional management for severe low body weight. However, such patients sometimes terminate inpatient treatment prematurely because of resistance to treatment, poor motivation for treatment, unstable emotions, and problematic behaviors. In this study, the psychopathological factors related to the personality of anorexic patients that might predict discontinuation of inpatient treatment were investigated using the Minnesota Multiphasic Personality Inventory (MMPI).

METHODS

Subjects were 75 consecutive anorectic inpatients who received cognitive behavioral therapy with a behavior protocol governing privileges in a university hospital based general (not psychiatric) ward. The MMPI was done on admission for all patients. A comparison was done of patients who completed the process of inpatient treatment, including attainment of target body weight (completers), and patients who dropped out of inpatient treatment (dropouts).

RESULTS

No significant differences between completers (n = 51) and dropouts (n = 24) were found in the type of eating disorder, age of onset, duration of illness, age, or BMI at admission. Logistic regression analysis found the MMPI scales schizophrenia (Sc), hypomania (HYP), deviant thinking and experience, and antisocial attitude to be factors predicting completion or dropout.

CONCLUSION

Dropouts have difficulty adapting to inpatient treatment protocols such as our behavior protocol governing privileges because they have social and emotional alienation, a lack of ego mastery (Sc), emotional instability (HYP) and an antisocial attitude. As a result, they have decreased motivation for treatment, leave the hospital without permission, attempt suicide, or shoplift, which leads them to terminate inpatient treatment prematurely. Treatments based on cognitive behavioral therapy with a behavior protocol governing privileges should be carefully adopted for anorectic patients who exhibit the psychopathological elements identified in this study.

摘要

背景

神经性厌食症常需住院治疗，除了针对极低体重的身体和营养管理外，还包括心理治疗干预。然而，此类患者有时会因治疗抵触、治疗动机差、情绪不稳定和行为问题而提前终止住院治疗。本研究使用明尼苏达多相人格测验（MMPI）调查了与厌食症患者人格相关的可能预测住院治疗中断的心理病理因素。

方法

研究对象为在一所大学附属医院的普通（非精神科）病房接受认知行为治疗并遵循行为规范的 75 名连续住院的神经性厌食症患者。所有患者入院时均进行 MMPI 测试。比较完成住院治疗过程（包括达到目标体重）的患者（完成者，n = 51）和退出住院治疗的患者（脱落者，n = 24）。

结果

完成者（n = 51）和脱落者（n = 24）在饮食障碍类型、发病年龄、病程、年龄或入院时 BMI 方面无显著差异。逻辑回归分析发现，MMPI 量表精神分裂症（Sc）、轻躁狂（HYP）、异常思维和体验以及反社会态度是预测完成或脱落的因素。

结论

脱落者难以适应住院治疗方案，如我们的行为规范管理特权的方案，因为他们存在社会和情感上的疏远、自我控制不足（Sc）、情绪不稳定（HYP）和反社会态度。因此，他们的治疗动机降低，未经允许离开医院，试图自杀或盗窃，导致他们提前终止住院治疗。对于表现出本研究中确定的心理病理特征的厌食症患者，应谨慎采用基于认知行为治疗并管理特权的行为规范的治疗方法。