Misdrahi David, Verdoux Helene, Lançon Christophe, Bayle Franck
Département de Psychiatrie Adulte, Centre Hospitalier Charles Perrens, Bordeaux, France.
Compr Psychiatry. 2009 Mar-Apr;50(2):181-5. doi: 10.1016/j.comppsych.2008.06.010. Epub 2008 Aug 23.
The quality of the relationship between patient and therapist can be considered a cornerstone of psychiatric practice. Nonadherence is one of the leading problems affecting antipsychotic effectiveness in schizophrenic patients and represents a poor prognostic factor for schizophrenia. Among the factors influencing adherence, the clinician's style of communication and the therapeutic relationship (TR) are recognized as key points. The measures of TR have been broadly explored in psychotherapy process but have received little attention in the treatment of severe mental illness in the context of routine mental health. Our objective was to build a self-rating scale easy to use in clinical psychiatric practice to assess TR, including drug-taking aspects and the relationship with the clinician on a day-to-day basis. A secondary objective was to assess the scale's validity and the association between TR and adherence.
The study was conducted with 92 consenting inpatients who met specified criteria for schizophrenia and schizoaffective disorders (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). Assessments of TR were obtained by the 4-Point ordinal Alliance Self-report and an 8-cm visual analog scale completed by the patient 1 week before discharge, after the remission of acute symptomatology. Adherence behavior was estimated with a new valid and reliable questionnaire called the Medication Adherence Rating Scale. Factor analysis was performed.
Internal consistency was assessed by calculating Cronbach alpha, which revealed a highly satisfactory value (alpha = .91). After oblique rotation was run, 2 understandable factors were extracted that we termed empathy experienced and psychoeducation.
Therapeutic relationship with the clinician can be considered a prerequisite for positive treatment course and outcome. The detection of subpopulations characterized by determinants of poor TR could be the first step toward improving schizophrenia prognosis linked to poor adherence.
患者与治疗师之间的关系质量可被视为精神病学实践的基石。不依从是影响精神分裂症患者抗精神病药物疗效的主要问题之一，也是精神分裂症预后不良的因素。在影响依从性的因素中，临床医生的沟通方式和治疗关系被认为是关键因素。治疗关系的测量在心理治疗过程中已得到广泛探讨，但在常规心理健康背景下的严重精神疾病治疗中却很少受到关注。我们的目标是构建一种易于在临床精神病学实践中使用的自评量表，以评估治疗关系，包括日常服药方面以及与临床医生的关系。第二个目标是评估该量表的有效性以及治疗关系与依从性之间的关联。
该研究对92名符合精神分裂症和分裂情感性障碍特定标准（《精神障碍诊断与统计手册》第四版）的同意参与的住院患者进行。治疗关系评估通过4点有序联盟自评量表以及患者在急性症状缓解后出院前1周完成的8厘米视觉模拟量表进行。使用一种名为药物依从性评定量表的新的有效且可靠的问卷来评估依从行为。进行了因子分析。
通过计算克朗巴哈系数评估内部一致性，结果显示值非常令人满意（α = 0.91）。进行斜交旋转后，提取出2个可理解的因子，我们将其称为体验到的同理心和心理教育。
与临床医生的治疗关系可被视为积极治疗过程和结果的先决条件。识别以治疗关系差的决定因素为特征的亚群体可能是改善与依从性差相关的精神分裂症预后的第一步。
