Objective To evaluate the efficacy of brief cognitive behavioral therapy (BCBT) combined with routine treatment (RT) for patients with schizophrenia in communities of Beijing.Methods 64 patients who met the criteria for schizophrenia according to the International Statistical Classification of Diseases and Related Health Problem,Tenth Revision (ICD-10) were randomly allocated to two groups,one group received 8 sessions of BCBT combined RT and the other group received only RT.All the subjects were evaluated using the Positive and Negative Syndrome Scale (PANSS),Schedule for Assessing Insight (SAI) and Personal and Social Performance Scale (PSP) at baseline,weeks 12,38 and 64.The effective and recurrence rates were also calculated and compared between the two groups.Results (1) Compared with the baseline,the scores of PANSS total (all P=0.000),PANSS-positive (all P=0.000),PANSS-negative (P=0.049,0.045,0.024) and PANSS-general (all P=0.000) in BCBT group decreased significantly at weeks 12,38 and 64.The scores of PANSS total (P=0.001,0.004)and PANSS-general (P=0.003,0.001)in RT group decreased significantly at 38 and 64 week and the score of PANSS-positive (P-0.002) in RT group decreased significantly at 38 week compared with the baseline.The scores of PANSS total (53.9± 10.9,51.0±11.1,48.1 ± 11.9)and PANSS-negative (12.1±4.3,12.1 ±4.3,11.2±4.4) in BCBT group were significandy lower than that in RT group (59.4±13.2,57.3±11.9,57.6±12.9;14.3±5.2,14.4±5.1,14.3±5.1) at 12,38 and 64 week (F=3.875,4.747,9.943 ; P=0.042,0.033,0.002 ; F=7.989,8.814,14.355 ; P=0.006,0.004,0.000)and the scores of PANSS-positive and PANSS-general were significantly lower than that in RT group (10.8±3.8 vs.12.8±4.3; 25.6±5.3 vs.28.7±6.8) at 64 week (F=5.223,P=0.040; F=4.229,P=0.044).(2) After treatment,the score of SAI in BCBT group increased significantly (P=0.000,0.001,0.000)and there was no change of SAI in RT group (all P=1.000).The score of SAI in BCBT group (9.4± 3.0,10.4±3.6) were significantly higher than that of RT group (7.0±3.7,7.8±3.9) at 12 and 64 week (F=8.139,8.936;P=0.006,0.004).(3) The scores of PSP in BCBT group increased significantly after treatment (all P＜0.01) and the scores of PSP in RT group increased significantly at 38 and 64 week (P=0.000,0.030).The scores of PSP in BCBT group (69.1±13.0,75.6± 12.6) were significantly higher than that of RT group (63.4±11.6,61.9± 10.8)at 38 and 64 week (F=7.548,21.419,P=0.042,0.000).(4) By the end of follow-up,the effective rates of CBT and RT group were 59.4％ (19/32) and 28.1％ (9/32) respectively and the difference between the two groups was significant (X2=6.349,P＜0.05).The recurrence rates of both groups were 9.4％ (3/32).Conclusions Both RT and BCBT combined with RT showed benefits on the overall symptoms,positive symptoms,general psychopathology symptoms and social functioning of community patients with schizophrenia,and the latter had better effect than the former in the long term.Adjunct BCBT could also improve patients' negative symptoms and insight better than only RT.

目的 分析探讨精神分裂症患者生活质量与非理性信念的关系,为认知行为治疗提高患者的生活质量提供理论指导.方法 选取符合DSM-Ⅳ中精神分裂症诊断标准的医院门诊和住院患者共200例,采用世界卫生组织生存质量测定量表简表(WHOQOL-BREF)和非理性信念量表(IBS)对患者进行测评,收回有效问卷182例,分析患者生活质量与非理性信念的相关性.结果 患者生活质量总分及4个因子分与非理性信念的低挫折耐受呈负相关(r分别为-0.348,-0.405,-0.309,-0.256,-0.394; P＜0.01),与概括化评论呈负相关(r分别为-0.357,-0.401,-0.325,-0.295,-0.413; P＜0.01).低挫折耐受和概括化评论可以作为总体生活质量和心理因子的预测指标(F分别为21.231,21.015; P＜0.01);概括化评论可以作为总体生活质量及生理、社会关系、环境因子的预测指标(F分别为15.292,12.020,9.011; P＜0.01).结论 精神分裂症患者的非理性信念影响患者的生活质量的各个层面,非理性信念中的低挫折耐受和概括化评论可作为患者生活质量的预测指标.

Objective To survey the situation and related factors of maintenance medication treatment in schizophrenic patients re-hospitalized for relapse.Methods 362 patients re-admitted with schizophrenia and their relatives were interviewed with questionnaire which included 16 factors that might affect maintenance medication treatment.Results 63.8% patients stopped medication and 21.1% patients were on low-dose maintenance medication treatment by themselves,while 7.7% patients were on reasonable dose anti-psychotics in 2 years.The time of maintenance medication treatment related with insight(OR=2.2144,P=0.001),family care(OR=4.8842,P=0.025),outcomes of treatment(OR=2.2056,P=0.007) and negative life events(OR=0.4529,P=0.003).Conclusion Schizophrenic patients re-admitted with relapse often withdraw or reduce their medication by themselves,which risked with poor insight,poor therapeutic effect,poor care from their family,and more negative life events.