Velligan Dawn I, Roberts David, Mintz Jim, Maples Natalie, Li Xueying, Medellin Elisa, Brown Matt
University of Texas Health Science Center at San Antonio, Department of Psychiatry, M.S. # 7792, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, United States.
University of Texas Health Science Center at San Antonio, Department of Psychiatry, M.S. # 7792, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, United States.
Schizophr Res. 2015 Jul;165(2-3):175-80. doi: 10.1016/j.schres.2015.04.008. Epub 2015 May 1.
Among individuals with schizophrenia, those who have persistent and clinically significant negative symptoms (PNS) have the poorest functional outcomes and quality of life. The NIMH-MATRICS Consensus Statement indicated that these symptoms represent an unmet therapeutic need for large numbers of individuals with schizophrenia. No psychosocial treatment model addresses the entire constellation of PNS.
51 patients with PNS were randomized into one of two groups for a period of 9 months: 1) MOtiVation and Enhancement (MOVE) or 2) treatment as usual. MOVE is a home based, manual-driven, multi-modal treatment that employs a number of cognitive and behavioral principles to address the broad range of factors contributing to PNS and their functional consequences. The components of MOVE include: Environmental supports to prompt initiation and persistence, in-vivo skills training to ameliorate deficits and encourage interaction, cognitive behavioral techniques to address self-defeating attitudes, in-vivo training in emotional processing to address affective blunting and problems in identifying emotions, and specific techniques to address the deficits in anticipatory pleasure. Patients were assessed at baseline and each 3 months with multiple measures of negative symptoms.
Repeated measures analyses of variance for mixed models indicated significant Group by Time effects for the Negative Symptom Assessment (NSA; p<.02) and the Clinical Assessment Interview for Negative Symptoms (CAINS; p<.04). Group differences were not significant until 9 months of treatment and were not significant for the Brief Negative Symptom Scale (BNSS).
Further investigation of a comprehensive treatment for PNS, such as MOVE, is warranted.
在精神分裂症患者中，那些存在持续且具有临床显著意义的阴性症状（PNS）的患者，其功能结局和生活质量最差。美国国立精神卫生研究所（NIMH）-测量与治疗研究改善精神分裂症认知（MATRICS）共识声明指出，这些症状表明大量精神分裂症患者的治疗需求未得到满足。没有任何心理社会治疗模式能解决PNS的所有方面。
51名PNS患者被随机分为两组，为期9个月：1）动机与强化（MOVE）组；2）常规治疗组。MOVE是一种基于家庭、手册指导的多模式治疗，采用多种认知和行为原则来解决导致PNS及其功能后果的广泛因素。MOVE的组成部分包括：促进启动和坚持的环境支持、改善缺陷和鼓励互动的现场技能训练、解决自我挫败态度的认知行为技术、解决情感迟钝和情绪识别问题的情感加工现场训练，以及解决预期愉悦缺陷的特定技术。在基线时以及每3个月对患者进行评估，采用多种阴性症状测量方法。
混合模型的重复测量方差分析表明，阴性症状评估（NSA；p<.02）和阴性症状临床评估访谈（CAINS；p<.04）存在显著的组×时间效应。直到治疗9个月时，组间差异才显著，且简明阴性症状量表（BNSS）的差异不显著。
有必要对PNS的综合治疗方法，如MOVE，进行进一步研究。
