Mental Health Centre Copenhagen, Copenhagen University Hospital, Bispebjerg Bakke 23, opg.13A, 3. 2400 Copenhagen NV, 0045 20607551 Denmark
J Clin Psychiatry. 2015 Jan;76(1):e83-90. doi: 10.4088/JCP.13m08814.
Working alliance between patients with a first-episode psychosis and their case manager is regarded as a key element in specialized early intervention services. The impact of this patient-case manager dyad on functional and clinical outcome is unknown. We aimed to investigate if a strong working alliance was associated with fewer clinical symptoms and better social functioning.
In a cross-sectional design, patients with first-episode schizophrenia spectrum disorders (ICD-10, F20-29) were included after 18 months of treatment (N = 400). Baseline data were collected between June 2009 and December 2011. Symptoms were assessed using Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS), Global Assessment of Functioning (GAF), Brief Assessment of Cognition in Schizophrenia (BACS), Working Alliance Inventory (WAI), and General Self-Efficacy (GSE). Linear regression analyses were adjusted for age, sex, cognition, and self-efficacy.
Results revealed significant associations between working alliance and fewer negative (β = -0.12; 95% CI, -0.19 to -0.04) and disorganized symptoms (β = -0.06; 95% CI, -0.11 to -0.01), and between working alliance and better social functioning (β = 1.45; 95% CI, 0.55 to 2.36). General self-efficacy mediated the effect of working alliance, explaining 14%-18% of the variance in associated outcomes. Global level of cognitive functioning, compliance, and self-efficacy influenced clinical and functional outcome more strongly than working alliance.
Better working alliance was weakly associated with fewer negative and disorganized symptoms and better social functioning. A strong working alliance may be a prerequisite for adherence to the specialized early intervention services treatment, providing the basis for positive treatment outcome.
ClinicalTrials.gov identifier: NCT00914238.
患者与个案经理之间的工作联盟被认为是专业早期干预服务的关键要素。这种医患二人组对功能和临床结果的影响尚不清楚。我们旨在调查是否强烈的工作联盟与较少的临床症状和更好的社会功能相关。
在一项横断面设计中，纳入了首次出现精神分裂症谱系障碍的患者（ICD-10，F20-29），这些患者在接受治疗 18 个月后入组（N=400）。基线数据收集于 2009 年 6 月至 2011 年 12 月之间。使用阳性症状评定量表（SAPS）、阴性症状评定量表（SANS）、总体功能评定量表（GAF）、Brief Assessment of Cognition in Schizophrenia（BACS）、工作联盟量表（WAI）和一般自我效能感量表（GSE）评估症状。线性回归分析调整了年龄、性别、认知和自我效能感。
研究结果显示，工作联盟与较少的阴性（β=-0.12；95%置信区间，-0.19 至-0.04）和紊乱症状（β=-0.06；95%置信区间，-0.11 至-0.01）之间存在显著关联，工作联盟与更好的社会功能之间也存在关联（β=1.45；95%置信区间，0.55 至 2.36）。一般自我效能感中介了工作联盟的影响，解释了相关结果中 14%-18%的变异。整体认知功能水平、依从性和自我效能感对临床和功能结果的影响比工作联盟更强。
更好的工作联盟与较少的阴性和紊乱症状以及更好的社会功能相关。强烈的工作联盟可能是遵守专业早期干预服务治疗的前提，为积极的治疗结果提供基础。
ClinicalTrials.gov 标识符：NCT00914238。
