Comprehensive treatment of schizophrenia with cognitive rehabilitation therapy

Beijing Hui Long Guan Hospital, Department of psychology, the 17 District in the hospital for schizophrenia patients in addition to routine

Content

Beijing Hui Long Guan Hospital, Department of psychology, the 17 District in the hospital for schizophrenia patients in addition to routine drug treatment, the patient for individual and group psychotherapy is one of the characteristics of the treatment of the 17 areas. Many relatives of schizophrenia patients hospitalized in 17 all the way to the hospital for treatment in the choice, they think the comprehensive psychological Department of Huilongguan hospital, to improve patients' social skills, prevention of recurrence and early recovery of valuable.

Contact the hospital ward Tel: 010-62715511-6372, ward director Guo Bin, deputy director of physicians

010-62715511-6217, Zhang Chunmiao, head nurse.

In April 2007, our hospital set up psychological therapeutic room. To provide psychological counseling and treatment services for patients in 17 districts, which is very popular among the patients and their families. The therapist in the face of the patient with little disturbance from medical diagnosis and imprisonment, and not because of illness It differs from man to man. different psychological treatment, such than symptomatic treatment have more pertinence and objectivity, to truly respect patients, people-oriented; psychological therapists. The deep reason behind the symptoms will explore after the basic understanding of the patient's symptoms. Including the patient's upbringing, family education, stress events, by solving the deep reason to relieve symptoms result from the root, reduce the recurrence rate. From the cognitive level to help patients to accept and adjust the understanding of symptoms, for the remission of patients, psychological treatment can help them to improve social adaptability, enhance social skills, as soon as possible to return to society.

Schizophrenia patients is the most passive defect due to long-term hospitalization or from social life, its social function, decline in employment competition ability, especially in patients with chronic, and antipsychotic drugs on these behavioral changes have little effect. In addition to the training of life behavior token system management, on chronic schizophrenia traditional repeated research, behavioral therapy more and more concentrated in the social skill training, occupation training, assertive community treatment plan.

The research shows that skills (social skills training) is an effective way to learn specific social behaviors, including basic, social problem solving, cognitive recovery and other models. The author has introduced the social and independent living skills training program designed by American scholars for schizophrenia patients [3]. The newly developed support employment program (supported employment programs), assertive community treatment program (assertive community treatment program) to reduce prevention has certain curative effect on readmission rate and recurrence of the employment competition ability.

But some researchers believe that the social skills training only to enhance the patients' social skills, occupation rehabilitation program only improve the competitive employment opportunities, and had no significant effect on the prevention of recurrence; assertive community treatment technology has not on social rehabilitation or occupation role. Nevertheless, the improvement of social skills, access to competitive employment is still very valuable for patients.

Family therapy has been widely accepted

Family intervention for patients with schizophrenia has been generally accepted. Family therapy is one of the most studied methods in the literature. One of the more targeted treatment of schizophrenia:

(a) the psychological education of family therapy: a large number of studies show that in schizophrenia relapse prevention and readmission rate to measure the adoption behavior and psychological education technology of family therapy is better than traditional outpatient care or individual therapy, family therapy involves the recurrence rate of nearly 24%, which received conventional treatment the recurrence rate was 64%[2]. The most basic point of psychological education is to explain the various possible causes and possible treatments, and then to provide a more effective way to deal with interpersonal problems. The specific implementation includes the following two aspects:

1 impart basic knowledge about the nature, development and treatment of mental illness.

2 help family members understand the current problems and how to solve them.

(two) crisis intervention: Goldstein method according to the orientation of family crisis intervention theory and design, is developed to solve the acute problems of mental illness, including patients and their families to meet regularly with the doctor, treatment to help family members effectively identify the tensions existing and / or may happen in the future or potential destructive tendencies of things, and provides a feasible way to deal with.

Treatment is divided into four steps: 1 for patients before and after stressful events may exist, and these events and the incidence of patients linked; identify 2 to 3 of the most obvious influence on patient events in which 2; 3 are proposed to avoid or cope with these tensions strategy and implementation; 4 to improve their the potential ability to foresee stressful event. The main purpose of family crisis intervention is to solve the conflict in the family, and the other is to reduce the other two social factors. However, there are few researches on crisis intervention, and it has been shown that the combination of crisis intervention and other family services is an acceptable way to treat severe mental disorders.

(three) family therapy of behavioral patterns: Falloon and Tarrier et al. Applied behavior or problem solving methods to pay more attention to training the whole family members to solve the internal problems and the skills of communication.

As they put forward including effective treatment of the patients with schizophrenia: 1 about schizophrenia education content; 2 communication training, such as role-playing exercises, imitation, strengthen the training of problem solving; 3: structural problem solving instruction training of family members.

(four) treatment of emotion (reducing expressed emotion treament): Leff and Vaughn are major advocates of the theory of emotional expression (expressed, EE). At present, a lot of family intervention for mental patients is one of the necessary conditions for EE, and the other is to reduce the level of EE in the family as another therapeutic target. Most studies suggest that high EE families have high rates of abuse, hostility, or excessive emotional involvement, and patients have a higher rate of recurrence.

Leff is proposed to reduce the treatment of emotional expression: 1 short-term etiology, symptoms of psychosis, of course and management of this kind of disease education; including 2 group treatment process level of emotional expression, two family members, family members of patients with high EE expression decreased to the patient accused of evaluation, hostility and excessive intervention etc. experience, learning expression from low EE families; including 3 patients and their families, individual family treatment, learn to deal with various problems in the family in the treatment of the help. However, there is no clear correlation between the recurrence and the decrease in the level of emotional expression, because the high level of emotional expression may be the result of the recurrence itself.

(five) family therapy of psychodynamic models: a study has reported that family therapy can also be used in patients with severe mental disorders. As Jones pointed out that the main principle of this mode of treatment is disrupt family life is caused by psychological projection process between family members, this is all the members are unconsciously involved in the process of this interaction is the center point of treatment. However, the only studies do not support the use of psychodynamic therapy in patients with schizophrenia.

The meta analysis of Pitschel-Walz G schizophrenia family intervention on the 25 spirit, results show that family intervention can effectively reduce family stress, reduce the relapse rate of the disease, and different types of family intervention have similar results; in addition to drug treatment, and to provide the families of the patient's psychological supporters have obvious treatment is superior to drug treatment only; the author also makes a comparison between the family intervention and various other therapies used in combination, but the results showed that combination therapy is not a focus on patient and family treatment methods produce better results.

It is pointed out that it is necessary and essential for the treatment of schizophrenia. Bustillo has also summarized the research on the treatment of schizophrenia since 1996. It is believed that the relatively simple and long-term psychological education of family therapy can be used to deal with most schizophrenia.

Cognitive or cognitive behavioral therapy - the effect is still difficult to conclude

Mental disorders have different degrees of cognitive impairment, such as schizophrenia patients with the most important cognitive impairment in memory, attention and executive function. These not only affect the cognitive impairment of patients' social and occupation ability, has close relationship with the occurrence and development of psychiatric symptoms, such as patients on their disease knowledge is certainly correlated with cognitive function, the study also found that reading mechanism of auditory hallucinations may be associated with. Therefore, in recent years, many researchers are interested in the application of cognitive or cognitive behavior oriented psychotherapy in schizophrenia.

The first major cognitive behavioral methods for treatment of the patient's symptoms, such as hallucinations, paranoia and other treatment of psychiatric symptoms, especially for those on the traditional antipsychotic effects of poor mental patients, cognitive therapy is also useful thinking barriers to chronic mental patients; recently some researchers for mental patients brain disorders such as attention, memory and other cognitive training; others for mental patients in the acute phase of. The cognitive behavior intervention for schizophrenia patients emphasizes the subjective nature of the mental symptoms, the challenge of the evidence, the reality test of these beliefs and experiences.

Bustillo [2] review since 1996 by the cognitive behavioral therapy effect on psychotic symptoms drugs ineffective, the results showed the cognitive behavior combined with routine treatment than conventional treatment alone to reduce and reduce the recurrence rate in the overall effect on the symptoms, but some studies suggest that cognitive behavioral therapy does not support than the good treatment effect, but also need to accept special training for implementation, so it is difficult to determine its effect.

Psychotherapy (Diagnosis-specific) - a new treatment concept for specific diagnosis

It is a treatment designed for people with severe mental disorders. Researchers have proposed the etiology of psychotherapy (etiological psychotherapy) and psychological rehabilitation therapy (rehabilitative psychotherapy) two claims, that most conventional psychotherapy is based on etiology, and severe mental illness or chronic mental patients during the recovery period, the implementation of support for the treatment of the basic characteristics of the behavior are mainly the nature of rehabilitation that is, the non pathogenic (nonetiologic), this therapy belongs to the latter.

It is different from most of the psychological treatment is required for the diagnosis and treatment of diseases that are more flexible, such as the healer must revise its attitude to adapt to the clinical types and stages of patients with disorders; its basic components in addition to the psychological education, trust, and patience to listen to the important and realistic emotional support, encourage and guide the crisis etc. some non-specific treatment activities. Hogart and colleagues describe the personalized treatment of patients with schizophrenia (personal therapy) clinical trial of [19], also think that personalized therapy is associated with disease (disorder-relevant) and disease specific (disorder-specific), the theory is based on stress susceptibility model (stress-vulnerability model); that the stress related disorders and emotional adjustment the symptoms of the disease associated; advocate the use of periods according to the rehabilitation of patients increasingly complex interventions, using elastic treatment technology to meet the needs and preferences of individuals, defects.

Such as the relationship between base period of individualized treatment mainly focused on the relationship of stress and symptoms; the treatment of medium-term goal is to promote the internal emotional stressors clues about the self consciousness, according to individual needs and preferences, the strategy of self protection, social skills and social perception treatment, relaxation exercises and other aspects of the treatment period on training; the relationship between the patient's living environment and the internal state of the internal audit, to provide opportunities for patients to adapt to the development of adverse reactions, including the reactions of others and symptoms of stress, self contact, enhance social skills training including the identification and conflict of interpersonal relationship, the criticism emphasizes treatment. The time of intervention is determined according to the individual's response. In order to achieve continuous progress, the patient should be treated as soon as possible. Hogart et al. Reported that in 3 years of follow-up, the number of patients in the study could be improved to the progression of personalized therapy ().

Individualized therapy promotes the transformation of clinical thinking, such as from the general question "what is the best treatment for this mental disorder? "On the other hand, it is thought that the specific binding of any of these interventions may have the best therapeutic effect on this particular type of patient in a particular period of the disease or recovery".

Characteristics and summary of psychotherapy for schizophrenia

Although there are a lot of psychological treatments for schizophrenia research, but as everyone knows, today there is no treatment to heal a schizophrenia, this is the current treatment of mental disorders, is where people from different angles to treatment development of various kinds of reasons. Therefore, it is safe to say that there is no single method for the treatment of schizophrenia. The main goal of psychological therapy for schizophrenia is to reduce symptoms, reduce relapse rate and enhance social psychological adaptation function. The current treatment of schizophrenia patients, usually with the following characteristics:

1 patients were given a dose of antipsychotic drugs;

2 because most of these mental patients lack insight, less or no autonomy, most of these patients are treated with more active and direct treatment. At present, there are more commonly accepted psychotherapy methods:

Psychological education, supportive (individual or group) treatment;

Behavioral techniques include employment, social skills training, etc.;

The family therapy, including family education or community intervention, some researchers even suggested that regardless of whether the existence of family problems can be identified, the schizophrenia patients and their family contact can effectively, especially in reducing the recurrence of the disease, think of all the patients family should include psychological education program [1]. In addition, the past ten years, the study of cognitive behavioral therapy on schizophrenia has increased, but is still in the initial stage of application; dynamic psychotherapy or psychological analysis of less application effect is also not sure.

3 of the patients with schizophrenia psychological treatment of most chronic disease is in recovery stage or intermittent period or disease, although the Research Report of psychological treatment for acute mental disorders, but the exploration in this area is very small.

4 a new therapeutic concept is the emphasis on personalized therapy. In short, the treatment of patients with so many psychological treatment methods, should be based on the patient's ability to self function and patient acceptance of the right treatment options.

Author Deng Yunlong Tang Qiuping

 

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