Penn D L, Mueser K T
Department of Psychology, Illinois Institute of Technology, Chicago 60616-3793, USA.
Am J Psychiatry. 1996 May;153(5):607-17. doi: 10.1176/ajp.153.5.607.
This review is an update on the research evidence supporting psychosocial treatment for schizophrenia. It extends previous review articles by summarizing the literature on social skills training, family interventions, cognitive rehabilitation, and coping with residual positive symptoms.
The authors reviewed controlled treatment outcome studies of social skills training and family interventions. Different models of family therapy were contrasted. The current literature on cognitive rehabilitation and coping with residual positive symptoms was also examined.
Social skills training produces improvement on specific behavioral measures, although changes in symptoms and community functioning are less pronounced. Family interventions (i.e., family psychoeducation and behavioral family therapy) are highly effective for reducing families' expressed emotion and improving patients' relapse rates and outcomes. Furthermore, family interventions are also associated with reduced family burden. Cognitive rehabilitation and training in coping with positive symptoms appear to be promising interventions, but more controlled, group trials are needed before definite conclusions can be drawn.
The efficacy of a variety of different family intervention models, as well as social skills training, is supported by a large body of research. Future work needs to address improving delivery of existing psychosocial interventions, integrating these interventions with other psychosocial approaches (e.g., vocational rehabilitation and case management), identifying which patients will benefit from which treatments, isolating the "active" ingredients of family interventions (i.e., psychoeducation versus behavioral intervention), and identifying the amount of treatment (e.g., number of sessions) needed before treatment response is expected.
本综述是对支持精神分裂症心理社会治疗的研究证据的更新。它通过总结社会技能训练、家庭干预、认知康复以及应对残留阳性症状方面的文献，对先前的综述文章进行了扩展。
作者回顾了社会技能训练和家庭干预的对照治疗结果研究。对比了不同的家庭治疗模式。还研究了当前关于认知康复和应对残留阳性症状的文献。
社会技能训练在特定行为指标上有改善，尽管症状和社区功能的变化不太明显。家庭干预（即家庭心理教育和行为家庭治疗）在降低家庭的情感表达、提高患者的复发率和治疗效果方面非常有效。此外，家庭干预还与减轻家庭负担相关。认知康复和应对阳性症状的训练似乎是有前景的干预措施，但在得出明确结论之前，还需要更多对照的群组试验。
大量研究支持了多种不同家庭干预模式以及社会技能训练的疗效。未来的工作需要致力于改善现有心理社会干预的实施，将这些干预与其他心理社会方法（如职业康复和病例管理）相结合，确定哪些患者将从哪种治疗中受益，分离家庭干预的“有效”成分（即心理教育与行为干预），以及确定预期治疗反应所需的治疗量（如疗程数）。
