Hogarty G E, Kornblith S J, Greenwald D, DiBarry A L, Cooley S, Ulrich R F, Carter M, Flesher S
Department of Psychiatry, University of Pittsburgh School of Medicine, PA, USA.
Am J Psychiatry. 1997 Nov;154(11):1504-13. doi: 10.1176/ajp.154.11.1504.
The study of individual psychotherapeutic approaches to the treatment of schizophrenia has yielded equivocal findings, partly because of methodologic problems. Further, the ability of psychosocial treatments to prevent psychotic relapse appears to lessen over time. The authors' goal was to develop and test a demonstrably effective individual therapy for schizophrenia.
Using a study design that addressed previous methodologic issues, the authors evaluated personal therapy specifically designed to forestall late relapse in patients with schizophrenia. They evaluated the effectiveness of personal therapy over a period of 3 years after hospital discharge among 151 patients with schizophrenia or schizoaffective disorder diagnosed according to Research Diagnostic Criteria. The patients were randomly assigned to receive either personal therapy or contrasting therapies in one of two concurrent trials. One trial studied patients who were living with family (N = 97); the other studied patients who were living independent of family (N = 54).
All of the patients had extensive psychiatric histories, but only 44 (29%) experienced recurrent psychotic episodes over the 3-year study period, and only 27 (18%) prematurely terminated the study; most of those who left the study were in the no-personal-therapy conditions. Among patients living with family, personal therapy was more effective than family and supportive therapies in preventing psychotic and affective relapse as well as noncompliance. However, among patients living independent of family, those who received personal therapy had significantly more psychotic decompensations than did those who received supportive therapy.
Personal therapy had a positive effect on adverse outcomes among patients who lived with family. However, personal therapy increased the rate of psychotic relapse for patients living independent of family. The application of personal therapy might best be delayed until patients have achieved symptom and residential stability.
对治疗精神分裂症的个体心理治疗方法的研究结果并不明确，部分原因是方法学问题。此外，心理社会治疗预防精神病复发的能力似乎会随着时间推移而减弱。作者的目标是开发并测试一种对精神分裂症明显有效的个体治疗方法。
作者采用一种解决了先前方法学问题的研究设计，评估专门为预防精神分裂症患者晚期复发而设计的个人治疗。他们在151名根据研究诊断标准确诊为精神分裂症或分裂情感性障碍的患者出院后的3年时间里评估个人治疗的效果。在两项并行试验中，患者被随机分配接受个人治疗或对比治疗。一项试验研究与家人同住的患者（N = 97）；另一项研究独立于家人生活的患者（N = 54）。
所有患者都有广泛的精神病史，但在3年的研究期间，只有44名（29%）经历了反复的精神病发作，只有27名（18%）提前终止了研究；大多数退出研究的患者处于无个人治疗组。在与家人同住的患者中，个人治疗在预防精神病性和情感性复发以及不依从方面比家庭治疗和支持性治疗更有效。然而，在独立于家人生活的患者中，接受个人治疗的患者比接受支持性治疗的患者有明显更多的精神病性失代偿。
个人治疗对与家人同住的患者的不良结局有积极影响。然而，个人治疗增加了独立于家人生活的患者的精神病复发率。个人治疗的应用最好推迟到患者症状和居住状况稳定之后。
