基于正念的干预对慢性精神分裂症住院患者的疗效分析

doi:10.3969/j.issn.1674-8115.2022.12.006

上海交通大学学报（医学版） ›› 2022, Vol. 42 ›› Issue (12): 1693-1698.doi: 10.3969/j.issn.1674-8115.2022.12.006

• 论著 · 临床研究 • 上一篇

基于正念的干预对慢性精神分裂症住院患者的疗效分析

沈辉¹(), 吴悦娟², 朱慧娟¹, 徐初琛¹, 张莉¹, 范青¹^,³()

^1.上海交通大学医学院附属精神卫生中心康复科，上海 201108
^2.上海市徐汇区精神卫生中心康复科，上海 200232
^3.上海市中医神志病研究所，上海 201108

收稿日期:2022-07-27 接受日期:2022-11-17 出版日期:2022-12-28 发布日期:2022-12-28
通讯作者: 范青 E-mail:2637248841@qq.com;fanqing@smhc.org.cn
作者简介:沈辉（1979—），女，副主任医师，硕士；电子信箱：2637248841@qq.com。
基金资助:
上海市进一步加快中医药传承创新发展三年行动计划（2021年—2023年）[ZY(2021-2023)-0105];上海市“科技创新行动计划”临床医学领域项目(19411950800);上海交通大学“交大之星”计划“医工交叉研究基金”(YG2021QN135)

Analysis of therapeutic effect of mindfulness-based intervention on inpatients with chronic schizophrenia

SHEN Hui¹(), WU Yuejuan², ZHU Huijuan¹, XU Chuchen¹, ZHANG Li¹, FAN Qing¹^,³()

^1.Department of Rehabilitation, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 201108, China
^2.Department of Rehabilitation, Mental Health Center of Xuhui District, Shanghai 200232, China
^3.Shanghai Institute of Traditional Chinese Medicine for Mental Health, Shanghai 201108, China

Received:2022-07-27 Accepted:2022-11-17 Online:2022-12-28 Published:2022-12-28
Contact: FAN Qing E-mail:2637248841@qq.com;fanqing@smhc.org.cn
Supported by:
Three-year Action Plan of Shanghai to Further Accelerate the Inheritance, Innovation and Development of Traditional Chinese Medicine (2021?2023) [ZY (2021-2023)-0105];Clinical Medicine Project of Shanghai Science and Technology Committee Project(19411950800);Science Fund of Shanghai Jiao Tong University(YG2021QN135)

摘要/Abstract

摘要：

目的·探讨基于正念的干预（mindfulness-based intervention，MBI）对慢性精神分裂症住院患者的疗效。方法·纳入2021年4月—6月于上海交通大学医学院附属精神卫生中心住院治疗的慢性精神分裂症患者96例，采用随机数字表将其分为MBI组（n=48例）和对照组（n=48例）。MBI组患者在常规治疗的基础上合并5周MBI，对照组则维持常规治疗5周。收集患者的一般资料，比较2组患者在基线及5周后的阳性与阴性症状量表（Positive and Negative Syndrome Scale，PANSS）、弗莱堡正念调查量表（Freiburg Mindfulness Inventory，FMI）及自我同情量表（Self-compassion Scale，SCS）的评分。结果·一般资料中仅性别的组间差异具有统计学意义（P=0.041）。基线时，2组患者的PANSS、FMI、SCS总分及其各因子评分的组间差异均无统计学意义。5周后，MBI组患者PANSS的一般精神病理因子评分低于对照组（P_Bonferroni=0.044），FMI总分和接受因子评分均高于对照组（P_Bonferroni=0.018，P_Bonferroni=0.003），SCS总分亦高于对照组（P_Bonferroni=0.000）。结论·MBI能显著提高慢性精神分裂症住院患者的正念水平和自我同情能力，促进其一般精神病理症状的改善，有利于患者康复。

关键词: 慢性精神分裂症, 精神症状, 正念, 自我同情

Abstract:

Objective ·To investigate the therapeutic effect of mindfulness-based intervention (MBI) on inpatients with chronic schizophrenia. Methods ·A total of 96 patients with chronic schizophrenia hospitalized in Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine from April to June 2021 were enrolled. They were divided into MBI group (n=48) and control group (n=48) by using random number table. The patients in the MBI group were combined with 5-week MBI on the basis of routine treatment, while the patients in the control group were maintained with routine treatment for 5 weeks. The general data of patients were collected, and the scores of Positive and Negative Syndrome Scale (PANSS), Freiburg Mindfulness Inventory (FMI) and Self-compassion Scale (SCS) were compared between the two groups at baseline and 5 weeks later. Results ·In general data, only the gender difference between the two groups was statistically significant (P=0.041). At baseline, there was no statistically significant difference between the two groups in the total scores of PANSS, FMI and SCS and their factor scores. After 5 weeks, the general psychopathology score of PANSS in the MBI group was lower than that in the control group (P_Bonferroni= 0.044), the total score and acceptance score of FMI were higher than those in the control group (P_Bonferroni=0.018, P_Bonferroni=0.003), and the total score of SCS was also higher than that in the control group (P_Bonferroni=0.000). Conclusion ·MBI can significantly improve mindfulness level and self-compassion ability of hospitalized patients with chronic schizophrenia, and promote the improvement of general psychopathology symptom, which is conducive to rehabilitation.

Key words: chronic schizophrenia, psychiatric symptom, mindfulness, self-compassion

中图分类号:

R749.3

沈辉, 吴悦娟, 朱慧娟, 徐初琛, 张莉, 范青. 基于正念的干预对慢性精神分裂症住院患者的疗效分析[J]. 上海交通大学学报（医学版）, 2022, 42(12): 1693-1698.

SHEN Hui, WU Yuejuan, ZHU Huijuan, XU Chuchen, ZHANG Li, FAN Qing. Analysis of therapeutic effect of mindfulness-based intervention on inpatients with chronic schizophrenia[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(12): 1693-1698.

图/表 2

参考文献 26

1	HUANG Y Q, WANG Y, WANG H, et al. Prevalence of mental disorders in China: a cross-sectional epidemiological study[J]. Lancet Psychiatry, 2019, 6(3): 211-224.
2	GBD 2016 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016[J]. Lancet, 2017, 390(10100): 1260-1344.
3	KAHN R S, SOMMER I E, MURRAY R M, et al. Schizophrenia[J]. Nat Rev Dis Primers, 2015, 1: 15067.
4	SHEN H, CHEN M J, CUI D H. Biological mechanism study of meditation and its application in mental disorders[J]. Gen Psychiatr, 2020, 33(4): e100214.
5	CRAMER H, LAUCHE R, HALLER H, et al. Mindfulness- and acceptance-based interventions for psychosis: a systematic review and meta-analysis[J]. Glob Adv Health Med, 2016, 5(1): 30-43.
6	BARBIERI A, VISCO-COMANDINI F. Efficacy of third wave cognitive therapies in the treatment of psychosis: a meta-review[J]. Riv Psichiatr, 2020, 55(2): 61-70.
7	JANSEN J E, GLEESON J, BENDALL S, et al. Acceptance- and mindfulness-based interventions for persons with psychosis: a systematic review and meta-analysis[J]. Schizophr Res, 2020, 215: 25-37.
8	CHIEN W T, BRESSINGTON D, YIP A, et al. An international multi-site, randomized controlled trial of a mindfulness-based psychoeducation group programme for people with schizophrenia[J]. Psychol Med, 2017, 47(12): 2081-2096.
9	CHADWICK P, STRAUSS C, JONES A M, et al. Group mindfulness-based intervention for distressing voices: a pragmatic randomised controlled trial[J]. Schizophr Res, 2016, 175(1/2/3): 168-173.
10	SHEN H, ZHANG L, LI Y H, et al. Mindfulness-based intervention improves residual negative symptoms and cognitive impairment in schizophrenia: a randomized controlled follow-up study[J]. Psychol Med, 2021: 1-10.
11	刘丹, 范宏振, 赵艳丽, 等. 首发与慢性精神分裂症患者的P50感觉门控特征[J]. 中国心理卫生杂志, 2022, 36(4): 282-286.
	LIU D, FAN H Z, ZHAO Y L, et al. Characteristics of P50 sensory gating in patients with first-episode and chronic schizophrenia[J]. Chinese Mental Health Journal, 2022, 36(4): 282-286.
12	KAY S R, FISZBEIN A, OPLER L A. The positive and negative syndrome scale (PANSS) for schizophrenia[J]. Schizophr Bull, 1987, 13(2): 261-276.
13	WALACH H, BUCHHELD N, BUTTENMÜLLER V, et al. Measuring mindfulness: the Freiburg Mindfulness Inventory (FMI)[J]. Pers Individ Differ, 2006, 40(8): 1543-1555.
14	陈语. 弗莱堡正念调查量表(FMI)在中国大学生中的修订和信效度检验[D]. 北京: 北京师范大学, 2011.
	CHEN Y. Psychometric validation of the Freiburg Mindfulness Inventory-short version in Chinese university students sample[D]. Bei Jing: Beijing Normal University, 2011.
15	GARCIA-CAMPAYO J, NAVARRO-GIL M, ANDRÉS E, et al. Validation of the Spanish versions of the long (26 items) and short (12 items) forms of the Self-Compassion Scale (SCS)[J]. Health Qual Life Outcomes, 2014, 12: 4.
16	宫火良, 贾会丽, 郭天满, 等. 青少年自我同情量表的修订及其信效度检验[J]. 心理研究, 2014, 7(1): 36-40, 79.
	GONG H L, JIA H L, GUO T M, et al. Revision of adolescent self compassion scale and its reliability and validity test[J]. Psychological Research, 2014, 7 (1): 36-40,79.
17	LI Y, COSTER S, NORMAN I, et al. Feasibility, acceptability, and preliminary effectiveness of mindfulness-based interventions for people with recent-onset psychosis: a systematic review[J]. Early Interv Psychiatry, 2021, 15(1): 3-15.
18	SHENG J L, YAN Y, YANG X H, et al. The effects of mindfulness meditation on hallucination and delusion in severe schizophrenia patients with more than 20 years' medical history[J]. CNS Neurosci Ther, 2019, 25(1): 147-150.
19	TANG Y Y, HÖLZEL B K, POSNER M I. The neuroscience of mindfulness meditation[J]. Nat Rev Neurosci, 2015, 16(4): 213-225.
20	TABAK N T, HORAN W P, GREEN M F. Mindfulness in schizophrenia: associations with self-reported motivation, emotion regulation, dysfunctional attitudes, and negative symptoms[J]. Schizophr Res, 2015, 168(1/2): 537-542.
21	POMMIER E, NEFF K D, TÓTH-KIRÁLY I. The development and validation of the compassion scale[J]. Assessment, 2020, 27(1): 21-39.
22	COLLETT N, PUGH K, WAITE F, et al. Negative cognitions about the self in patients with persecutory delusions: an empirical study of self-compassion, self-stigma, schematic beliefs, self-esteem, fear of madness, and suicidal ideation[J]. Psychiatry Res, 2016, 239: 79-84.
23	DUDLEY J, EAMES C, MULLIGAN J, et al. Mindfulness of voices, self-compassion, and secure attachment in relation to the experience of hearing voices[J]. Br J Clin Psychol, 2018, 57(1): 1-17.
24	SUN T W, YAN Y X, JIN Y C, et al. Effects of mindfulness-based interventions on self-compassion: a meta-analysis[J]. Adv Psychol Sci, 2021, 29(10): 1808-1828.
25	HOCHHEISER J, LUNDIN N B, LYSAKER P H. The independent relationships of metacognition, mindfulness, and cognitive insight to self-compassion in schizophrenia[J]. J Nerv Ment Dis, 2020, 208(1): 1-6.
26	GU J, STRAUSS C, BOND R, et al. How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies[J]. Clin Psychol Rev, 2015, 37: 1-12.

Item	MBI group （n=48）	Control group （n=48）	t/U/χ² value	P value
Age/year	58.19±8.79	61.15±6.97	-1.827	0.071
Gender/n（%）			4.196	0.041
Male	27 （56.3）	17 （35.4）
Female	21 （43.8）	31 （64.6）
Marital status/n（%）			0.610	0.737
Married	11 （22.9）	9 （18.8）
Unmarried	27 （56.3）	26 （54.2）
Divorce or widowhood	10 （20.8）	13 （27.1）
Years of education/year	12.0 （9.8， 12.0）	12.0 （9.0， 12.0）	975.000	0.163
Number of hospitalizations/n	3.0 （2.0， 5.0）	3.0 （1.0， 6.0）	1 144.500	0.956
Course of disease/year	32.06±12.65	32.85±12.38	-0.310	0.757
Drug dose of equivalent OLZ/mg	14.8 （10.0， 20.6）	13.0 （7.6， 20.0）	1 046.500	0.438

Item	MBI group （n=48）	Control group （n=48）	t/U/χ² value	P value
Age/year	58.19±8.79	61.15±6.97	-1.827	0.071
Gender/n（%）			4.196	0.041
Male	27 （56.3）	17 （35.4）
Female	21 （43.8）	31 （64.6）
Marital status/n（%）			0.610	0.737
Married	11 （22.9）	9 （18.8）
Unmarried	27 （56.3）	26 （54.2）
Divorce or widowhood	10 （20.8）	13 （27.1）
Years of education/year	12.0 （9.8， 12.0）	12.0 （9.0， 12.0）	975.000	0.163
Number of hospitalizations/n	3.0 （2.0， 5.0）	3.0 （1.0， 6.0）	1 144.500	0.956
Course of disease/year	32.06±12.65	32.85±12.38	-0.310	0.757
Drug dose of equivalent OLZ/mg	14.8 （10.0， 20.6）	13.0 （7.6， 20.0）	1 046.500	0.438

Item	Baseline		Five weeks later		Group		Time		Group×Time		ANCOVA
Item	MBI group （n=48）	Control group （n=48）	MBI group （n=48）	Control group （n=48）	F value	P value	F value	P value	F value	P value	F value	P value
PANSS total score	56.02±11.79	56.42±9.58	54.06±10.71	55.69±8.53	0.155	0.695	0.075	0.785	4.654	0.034	5.950	0.017
P	11.60±4.09	12.02±3.30	11.50±3.81	11.92±3.13	0.031	0.861	2.982	0.088	0.213	0.646	0.283	0.596
N	15.81±5.14	15.38±3.52	15.21±5.05	15.23±3.38	0.048	0.826	0.506	0.478	2.797	0.098	2.553	0.114
G	28.69±5.33	29.02±4.59	27.42±4.53	28.54±4.10	0.726	0.396	0.055	0.815	4.311	0.041	6.667	0.011
FMI total score	26.85 ±7.30	26.31±8.21	29.81±7.85	26.40±8.97	4.546	0.036	0.388	0.535	5.045	0.027	8.057	0.006
Awareness	11.38±3.23	10.94±4.05	12.23±3.55	11.25±4.40	2.938	0.090	0.050	0.823	0.884	0.350	2.193	0.142
Acceptance	15.48±4.48	15.38±4.62	17.58±4.92	15.15±5.12	5.088	0.026	0.662	0.418	8.045	0.006	11.702	0.001
SCS total score	83.42±9.34	84.75±8.63	88.73±11.10	83.73±8.46	2.382	0.126	0.615	0.435	15.154	0.000	16.022	0.000
Common humanity	13.42±3.17	13.44±3.38	13.79±3.36	12.58±3.44	2.286	0.134	1.795	0.184	3.324	0.071	5.437	0.022
Self-judgment	14.69±3.70	15.54±4.39	16.85±4.13	16.38±3.44	0.231	0.632	4.038	0.047	1.325	0.253	0.413	0.522
Self-kindness	17.52±3.80	17.44±3.57	17.00±4.45	15.96±4.20	3.237	0.075	5.883	0.017	2.304	0.132	4.321	0.040
Isolation	11.92±3.47	12.02±3.29	13.65±3.25	12.96±3.02	0.037	0.849	4.925	0.029	0.510	0.477	0.506	0.479
Mindfulness	13.85±3.71	13.40±3.68	13.73±3.62	12.25±3.52	4.789	0.031	0.815	0.369	2.023	0.158	5.824	0.018
Over-identification	12.02±2.98	12.92±3.50	13.71±3.15	13.60±2.97	0.850	0.359	2.867	0.094	1.286	0.260	0.129	0.720

Item	Baseline		Five weeks later		Group		Time		Group×Time		ANCOVA
Item	MBI group （n=48）	Control group （n=48）	MBI group （n=48）	Control group （n=48）	F value	P value	F value	P value	F value	P value	F value	P value
PANSS total score	56.02±11.79	56.42±9.58	54.06±10.71	55.69±8.53	0.155	0.695	0.075	0.785	4.654	0.034	5.950	0.017
P	11.60±4.09	12.02±3.30	11.50±3.81	11.92±3.13	0.031	0.861	2.982	0.088	0.213	0.646	0.283	0.596
N	15.81±5.14	15.38±3.52	15.21±5.05	15.23±3.38	0.048	0.826	0.506	0.478	2.797	0.098	2.553	0.114
G	28.69±5.33	29.02±4.59	27.42±4.53	28.54±4.10	0.726	0.396	0.055	0.815	4.311	0.041	6.667	0.011
FMI total score	26.85 ±7.30	26.31±8.21	29.81±7.85	26.40±8.97	4.546	0.036	0.388	0.535	5.045	0.027	8.057	0.006
Awareness	11.38±3.23	10.94±4.05	12.23±3.55	11.25±4.40	2.938	0.090	0.050	0.823	0.884	0.350	2.193	0.142
Acceptance	15.48±4.48	15.38±4.62	17.58±4.92	15.15±5.12	5.088	0.026	0.662	0.418	8.045	0.006	11.702	0.001
SCS total score	83.42±9.34	84.75±8.63	88.73±11.10	83.73±8.46	2.382	0.126	0.615	0.435	15.154	0.000	16.022	0.000
Common humanity	13.42±3.17	13.44±3.38	13.79±3.36	12.58±3.44	2.286	0.134	1.795	0.184	3.324	0.071	5.437	0.022
Self-judgment	14.69±3.70	15.54±4.39	16.85±4.13	16.38±3.44	0.231	0.632	4.038	0.047	1.325	0.253	0.413	0.522
Self-kindness	17.52±3.80	17.44±3.57	17.00±4.45	15.96±4.20	3.237	0.075	5.883	0.017	2.304	0.132	4.321	0.040
Isolation	11.92±3.47	12.02±3.29	13.65±3.25	12.96±3.02	0.037	0.849	4.925	0.029	0.510	0.477	0.506	0.479
Mindfulness	13.85±3.71	13.40±3.68	13.73±3.62	12.25±3.52	4.789	0.031	0.815	0.369	2.023	0.158	5.824	0.018
Over-identification	12.02±2.98	12.92±3.50	13.71±3.15	13.60±2.97	0.850	0.359	2.867	0.094	1.286	0.260	0.129	0.720

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基于正念的干预对慢性精神分裂症住院患者的疗效分析

Analysis of therapeutic effect of mindfulness-based intervention on inpatients with chronic schizophrenia

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