Design and application evaluation of condensed version of social cognition interaction training intervention program in schizophrenia
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摘要:
目的 设计浓缩版社会认知交互训练(social cognition interaction training, SCIT)干预程序并探讨其对精神分裂症患者社会认知和社会功能的影响。 方法 选取2018年6月—2020年3月在杭州市第七人民医院住院治疗的70例精神分裂症患者，采用随机数字表法分为干预组(浓缩版SCIT干预+药物治疗)和等待组(仅药物治疗)，干预组31例和等待组32例完成干预后评估。干预前后采用阳性和阴性症状量表(PANSS)、个人和社会功能量表(PSP)、面部情绪识别任务(FEIT)及眼区心理阅读任务(ET)评估2组患者的精神病性症状、社会功能及社会认知水平。 结果 实施干预后，2组患者PANSS总分及各因子分较干预前显著降低(均P＜0.001)，但干预组PANSS总分及各因子分较等待组差异无统计学意义(均P＞0.05)；干预后2组患者个人与社会功能量表、面部情绪识别任务及眼区心理阅读任务评分均较干预前有所提高，且干预组评分[(70.23±6.39)分，(25.35±1.52)分，(29.48±2.67)分]显著高于等待组[(62.69±9.24)分，(22.19±2.24)分，(26.72±2.57)分]，差异均有统计学意义(均P＜0.001)。 结论 浓缩版SCIT干预可用于我国住院精神分裂症患者的临床干预，对该人群社会认知和社会功能有一定的康复疗效。 Abstract:Objective To design a condensed version of social cognition interaction training (SCIT) intervention program and explore the effects of SCIT on social functioning and social cognition in patients with schizophrenia. Methods Seventy patients with schizophrenia who were hospitalized in Hangzhou Seventh People ' s Hospital from June 2018 to March 2020 were recruited. They were randomly divided into the intervention group (condensed version of SCIT plus drug treatment) and waiting-list group (only drug treatment). Thirty-one patients in the intervention group and 32 patients in the waiting-list group completed the post-assessment. Positive and negative symptom scale (PANSS), personal and social performance scale (PSP), face emotion identification task (FEIT) and reading the mind in the eyes task (ET) were used to evaluate the psychosis symptoms, social function and social cognitive level of patients in the two groups before and after intervention. Results After the intervention, the total score and factor scores of PANSS of two groups were significantly lower than those before intervention (all P < 0.001), but there were no significant difference on the total score and factor scores of PANSS between the two groups (all P>0.05). The scores of PSP, FEIT and ET of two groups were significantly higher than those before intervention, and the scores of intervention group [(70.23±6.39) points, (25.35±1.52) points, (29.48±2.67) points] were higher than those of waiting-list group [(62.69±9.24) points, (22.19±2.24) points, (26.72±2.57) points], the differences were statistically significant (all P < 0.001). Conclusion The condensed version of SCIT is a feasible and promising intervention method for improving social cognition and social functioning among inpatients with schizophrenia in China. -
表 1 2组精神分裂症患者一般资料比较
Table 1. Comparison of general data between two groups of schizophrenic
组别 例数 年龄(x±s, 岁) 性别(例) 受教育年限(x±s, 年) 氯丙嗪当量(x±s, mg) 男性 女性 干预组 31 29.42±8.88 20 11 12.71±2.61 500.81±216.55 等待组 32 29.06±4.84 22 10 12.19±2.81 456.25±229.92 统计量 0.040a 0.127b 0.583a 0.626a P值 0.843 0.722 0.448 0.432 注：a为t值，b为χ2值。 
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表 2 浓缩版SCIT课程设计
Table 2. The design of condensed version of SCIT
阶段 浓缩版SCIT 课程目标 第一阶段：情绪知觉训练模块 原训练第1~2节课被浓缩为第1节课。
原训练第3~4节课被浓缩为第2节课。
原训练第5节课为浓缩版第3节课。
原训练第6节课为浓缩版第4节课。
原训练第7~8节课被浓缩为第5节课。1、开始建立治疗联盟;
2、介绍SCIT及社会认知的概念;
3、将情绪和心情的概念联系起来，定义七个基本概念的情绪;
4、识别面部表情和情绪之间的差异;
5、培养模仿与之相关的关键面部线索的技能;
6、继续提高识别面部情绪的能力，通过更新信息来改善面部表情，从而提高社会认知的灵活性情感猜测。第二阶段：心理理论和归因训练模块 原训练第9~10节课被浓缩为第6节课。
原训练第11~13节课被浓缩为第7节课。
原训练第14~15节课被浓缩为第8节课。
增加第9节课，强化训练Q20技术。练习策略1:想出其他猜测，理解事实和猜测之间的区别;
练习策略2:把事实和猜测分开，练习模糊不清的能力;
实践策略3:收集更多的证据。第三阶段：综合运用模块 原训练中的第16~20节课被浓缩为第10~12节课，综合运用课(出院后随访)，强调分享真实的社会状况。 练习学习处理人际关系问题和生活中的负面情绪的技巧。
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表 3 2组精神分裂症患者干预前后PANSS评分比较(x±s，分)
Table 3. Comparison of PANSS scores between two groups of schizophrenic before and after intervention (x±s, points)
组别 例数 阳性症状总分 阴性症状总分 一般症状总分 PANSS总分 干预前 干预后 干预前 干预后 干预前 干预后 干预前 干预后 干预组 31 18.23±7.42 11.71±3.78a 18.90±8.22 14.13±5.64a 32.87±7.82 25.55±6.15a 70.00±16.18 51.39±11.94a 等待组 32 19.44±8.54 11.63±3.44a 19.25±7.50 15.38±7.72a 34.38±7.05 25.31±5.41a 73.06±12.45 52.31±12.81a t值 -0.600 0.093 -0.175 -0.729 -0.803 0.162 -0.844 -0.296 P值 0.550 0.926 0.862 0.469 0.425 0.872 0.402 0.768 注：与同组干预前比较，aP＜0.01。
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表 4 2组精神分裂症患者干预前后社会功能和社会认知评估比较(x±s，分)
Table 4. Comparison of social functioning and social cognition between two groups of schizophrenic before and after intervention(x±s, points)
组别 例数 个人与社会功能量表 面部情绪识别任务 眼区任务 干预前 干预后 干预前 干预后 干预前 干预后 干预组 31 45.77±16.89 70.23±6.39a 21.81±2.10 25.35±1.52a 25.10±1.58 29.48±2.67a 等待组 32 50.00±13.44 62.69±9.24a 21.28±2.22 22.19±2.24a 25.06±1.83 26.72±2.57a t值 -1.101 3.755 0.964 6.598 0.079 4.191 P值 0.275 <0.001 0.339 <0.001 0.937 <0.001 注：与同组干预前比较，aP＜0.01。
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