Tarrier N, Yusupoff L, Kinney C, McCarthy E, Gledhill A, Haddock G, Morris J
Department of Clinical Psychology, School of Psychiatry and Behavioural Sciences, University of Manchester, Withington Hospital, Manchester M20 8LR, UK.
BMJ. 1998 Aug 1;317(7154):303-7. doi: 10.1136/bmj.317.7154.303.
To investigate whether intensive cognitive behaviour therapy results in significant improvement in positive psychotic symptoms in patients with chronic schizophrenia.
Patients with chronic schizophrenia were randomly allocated, stratified according to severity of symptoms and sex, to intensive cognitive behaviour therapy and routine care, supportive counselling and routine care, and routine care alone.
Adjunct treatments were carried out in outpatient clinics or in the patient's home.
87 patients with persistent positive symptoms who complied with medication; 72 completed treatment.
Assessments of positive psychotic symptoms before treatment and 3 months after treatment. Number of patients who showed a 50% or more improvement in symptoms. Exacerbation of symptoms and rates of readmission to hospital.
Significant improvements were found in the severity (F=5.42, df =2,86; P=0.006) and number (F=4.99, df=2,86; P=0.009) of positive symptoms in those treated with cognitive behaviour therapy. The supportive counselling group showed a non-significant improvement. Significantly more patients treated with cognitive behaviour therapy showed an improvement of 50% or more in their symptoms (chi2=5.18, df=1; P=0.02). Logistic regression indicated that receipt of cognitive behaviour therapy results in almost eight times greater odds (odds ratio 7.88) of showing this improvement. The group receiving routine care alone also experienced more exacerbations and days spent in hospital.
Cognitive behaviour therapy is a potentially useful adjunct treatment in the management of patients with chronic schizophrenia.
研究强化认知行为疗法是否能使慢性精神分裂症患者的阳性精神病性症状得到显著改善。
将慢性精神分裂症患者根据症状严重程度和性别进行分层，随机分配至强化认知行为疗法组与常规护理组、支持性咨询与常规护理组以及仅接受常规护理组。
辅助治疗在门诊诊所或患者家中进行。
87例持续存在阳性症状且依从药物治疗的患者；72例完成治疗。
治疗前及治疗3个月后对阳性精神病性症状进行评估。症状改善50%或以上的患者数量。症状加重情况及再次入院率。
接受认知行为疗法治疗的患者，其阳性症状的严重程度（F = 5.42，自由度=2,86；P = 0.006）和数量（F = 4.99，自由度=2,86；P = 0.009）均有显著改善。支持性咨询组有不显著的改善。接受认知行为疗法治疗的患者中，症状改善50%或以上的患者明显更多（卡方=5.18，自由度=1；P = 0.02）。逻辑回归表明，接受认知行为疗法使出现这种改善的几率几乎高出八倍（优势比7.88）。仅接受常规护理的组症状加重情况更多，住院天数也更多。
认知行为疗法在慢性精神分裂症患者的管理中是一种潜在有用的辅助治疗方法。
