动机性访谈对多次发作精神分裂症药物不依从患者的药物依从性和住院率的影响。
The effect of motivational interviewing on medication adherence and hospitalization rates in nonadherent patients with multi-episode schizophrenia.
机构信息
*To whom correspondence should be addressed; Department of Psychiatry, Academic Medical Centre, Meibergdreef 5, Amsterdam 1105 AZ, The Netherlands; tel: 31-20-8913500, fax: 31-20-8913702, e-mail:
出版信息
Schizophr Bull. 2013 Nov;39(6):1242-51. doi: 10.1093/schbul/sbt138. Epub 2013 Sep 26.
BACKGROUND
Medication nonadherence in patients with schizophrenia presents a serious clinical problem. Research on interventions incorporating motivational interviewing (MI) to improve adherence have shown mixed results.
AIMS
Primary aim is to determine the effectiveness of a MI intervention on adherence and hospitalization rates in patients, with multi-episode schizophrenia or schizoaffective disorder, who have experienced a psychotic relapse following medication nonadherence. Secondary aim is to evaluate whether MI is more effective in specific subgroups.
METHODS
We performed a randomized controlled study including 114 patients who experienced a psychotic relapse due to medication nonadherence in the past year. Participants received an adapted form of MI or an active control intervention, health education (HE). Both interventions consisted of 5-8 sessions, which patients received in adjunction to the care as usual. Patients were assessed at baseline and at 6 and 12 months follow-up.
RESULTS
Our results show that MI did not improve medication adherence in previously nonadherent patients who experienced a psychotic relapse. Neither were there significant differences in hospitalization rates at follow-up between MI and HE (27% vs 40%, P = .187). However, MI resulted in reduced hospitalization rates for female patients (9% vs 63%, P = .041), non-cannabis users (20% vs 53%, P = .041), younger patients (14% vs 50%, P = .012), and patients with shorter illness duration (14% vs 42%, P = .040).
CONCLUSIONS
Targeted use of MI may be of benefit for improving medication adherence in certain groups of patients, although this needs further examination.
背景
精神分裂症患者的药物治疗依从性是一个严重的临床问题。研究表明，将动机访谈（MI）融入干预措施以提高依从性的研究结果喜忧参半。
目的
主要目的是确定 MI 干预对经历过因药物治疗依从性差而导致精神复发的多发作精神分裂症或分裂情感障碍患者的依从性和住院率的影响。次要目的是评估 MI 是否对特定亚组更有效。
方法
我们进行了一项随机对照研究，纳入了 114 名在过去一年中因药物治疗依从性差而经历精神复发的患者。参与者接受了改良的 MI 或健康教育（HE）形式的积极对照干预。两种干预均包含 5-8 次治疗，患者在常规护理的基础上额外接受这些治疗。患者在基线、6 个月和 12 个月随访时进行评估。
结果
我们的结果表明，MI 并未改善过去因药物治疗依从性差而经历精神复发的患者的药物依从性。在随访期间，MI 和 HE 之间的住院率也没有显著差异（27%比 40%，P=0.187）。然而，MI 降低了女性患者（9%比 63%，P=0.041）、非大麻使用者（20%比 53%，P=0.041）、年轻患者（14%比 50%，P=0.012）和疾病持续时间较短的患者（14%比 42%，P=0.040）的住院率。
结论
针对特定患者群体，有针对性地使用 MI 可能会有益于提高药物依从性，但这需要进一步研究。
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