强制干预对精神科住院患者心理影响及其应对方式的研究_廖莉萍.pdf

黑龙江医学2023年1月25日第47卷第2期HEILONGJIANG MEDICAL JOURNALJan.25,2023Vol.47No.2强制干预对精神科住院患者心理影响及其应对方式的研究廖莉萍，朱珊珊，席永琴抚州市第三医院精神三科，江西抚州344000摘要目的：分析强制干预对精神科住院患者心理影响及其应对方式的效果。方法：选取2016年1月2020年12月在抚州市第三医院精神科住院的62例患者作为研究对象，所有患者采取强制干预。对比干预前和干预后患者的心理状态、应对方式、胁迫体验、精神障碍、症状自评量表、自知力因子、并发症发生率、中间型防御方式、病耻感及认知功能变化。结果：干预后患者焦虑、抑郁心理较干预前高，差异有统计学意义（t=8.035、7.681，P0.05）；干预后患者积极应对较干预前低，且消极应对较干预前高，差异有统计学意义（t=29.694、35.211，P0.05）；干预后患者精神障碍、自知力因子较干预前低，且胁迫体验较干预前高，差异有统计学意义（t=23.177、5.401、48.585，P0.05）；干预后患者强迫、敌对、偏执、精神病性临床症状较干预前少，差异有统计学意义（t=61.520、9.964、28.508、40.562，P0.05）；干预后患者回避、消耗倾向、隔离、理想化分数较干预前高，差异有统计学意义（t=17.089、20.747、25.133、17.518，P0.05）；干预后患者歧视度、病情掩饰分数较干预前高，且积极效应较干预前低，差异有统计学意义（t=18.853、16.377、16.943，P0.05）；干预后患者吸引和排斥、脆弱性、寻求赞许、依赖性分数较低，且强制性分数较干预前高，差异有统计学意义（t=13.097、5.658、6.290、3.226、5.752，P0.05）。结论：强制干预对精神科住院患者虽可以缓解精神障碍，但会增加患者负性情绪，让患者处于消极应对状态，出现胁迫体验，提高患者的防御功能，让患者感到羞耻，临床应尽量减少强制干预。关键词精神科；强制干预；应对方式doi10.3969/j.issn.1004-5775.2023.02.032学科分类代码320.57中图分类号R749文献标识码BStudy on the Psychological Effects of Compulsory Intervention on Inpatients in Psychiatry and their Coping Styles/LIAO Li-ping,ZHU Shan-shan,XI Yong-qin/Department of Psychiatry,Fuzhou Third Hospital,Fuzhou,Jiangxi,344000,ChinaAbstract Objective:To analyze the effect of compulsory intervention on the psychological impact of psychiatric inpatientsand their coping styles.Methods:A total of 62 patients who were hospitalized in the hospital from January 2016 to December2020 were selected as the research subjects,and all patients received compulsory intervention.The psychological state,copingstyle,coercive experience,mental disorder,symptom self-rating scale,insight factor,complication rate,intermediate defense style,stigma and cognitive function were compared before and after the intervention.Results:After the intervention,the anxiety and depression of the patients were higher than those before the intervention,and the difference was statistically significant(t=8.035,7.681,P0.05).After the intervention,the positive coping of the patients was lower than that before the intervention,and the negative coping was higher than that before the intervention,and the difference was statistically significant(t=29.694,35.211,P0.05).After the intervention,the factors of mental disorder and insight were lower than those before the intervention,and the coercion experience was higher than that before the intervention,and the differences were statistically significant(t=23.177,5.401,48.585,P0.05).After the intervention,the clinical symptoms of compulsion,hostility,paranoia and psychosis were less than those before theintervention,and the difference was statistically significant(t=61.520,9.964,28.508,40.562,P0.05).The scores of avoidance,consumption tendency,isolation and idealization of patients after intervention were higher than those before intervention,and thedifference was statistically significant(t=17.089,20.747,25.133,17.518,P0.05).After the intervention,the degree of discrimination and disease concealment scores of the patients were higher than those before the intervention,and the positive effect was lowerthan that before the intervention,and the differences were statistically significant(t=18.853,16.377,16.943,P0.05).After the intervention,the scores of attraction and rejection,vulnerability,seeking approval,and dependence were lower,and the coercivescores were higher than those before the intervention,and the differences were statistically significant(t=13.097,5.658,6.290,3.226,5.752,P0.05).Conclusion:Although compulsory intervention can alleviate mental disorders in psychiatric hospitalizedpatients,it will increase the negative emotions of patients,make patients in a negative coping state,experience coercive experiences,improve patients defense function,and make patients feel ashamed.Clinically,compulsory intervention should be minimized.Keywords Psychiatry;Coercive intervention;Coping styles235黑龙江医学2023年1月25日第47卷第2期HEILONGJIANG MEDICAL JOURNALJan.25,2023Vol.47No.2精神障碍是指在各种生物学、心理学及社会坏境因素的影响下，患者出现大脑功能异常，诱发认知、情感、意志及行为等精神活动产生不同程度障碍为临床特征的病症，其发病机制尚不明确，是全球多发的精神疾病之一。精神障碍患者会出现性格变化，生活能力下降，患者在发病时会出现狂躁、不安、胆怯等现象，同时还会伴有生活自理能力降低等症状，且患者自知功能受损，无法意识到自身病症拒绝接受治疗，无法得到有效医治，患者还会出现一些消极的想法，导致最后悲观绝望，严重的话还会使患者产生自杀倾向1-2。强制干预是指在违背患者自身意愿的情况下，不同程度的限制患者的人身自由，在特定的医疗机构接受治疗的一种治疗方式，是控制患者危险性行为的有效手段，又被称为非自愿住院治疗，能够保护精神疾病患者，帮助患者接受治疗，使患者尽快恢复健康，以免患者进行自我伤害，还可以改善患者的健康状况，但会让患者产生胁迫感，从而产生一系列的负面情绪3-4。本研究旨在分析强制干预对精神科住院患者心理影响及其应对方式的效果，报告如下。1资料与方法1.1一般资料选取2016年1月2020年12月在抚州市第三医院精神科住院的62例患者作为研究对象，所有患者采取强制干预。男 31 例，女 31 例；年龄 2547 岁，平均年龄（35.783.58）岁；病程 433 月，平均病程（18.471.85）月，所有患者的基线资料具有可比性（P0.05）。1.2选取标准（1）纳入标准：经中国精神障碍分类或诊断标准CCMD-3被确诊为精神疾病，未见其他精神疾病，对于常规治疗表现出明显抗拒，患者及家属知情签署同意书。（2）排除标准：伴有肝、肾等恶性肿瘤障碍，因其他精神障碍无法正常沟通，具有器质性精神障碍，在接受治疗前表现出焦虑、抑郁等负性情绪精神障碍，住院时间不超过48 h。1.3方法（1）评估工具，首先使用焦虑自评表（SAS）、抑郁自评表（SDS）、简易应对方式量表（SCSQ）、简明精神障碍评分表（BPRS）及胁迫体验量表（CES）。SAS、SDS量表适用于评估患者的主观感知，分别有20个问题，使用4分制评分法，是原始分数乘以1.25后取整数部分，50分以下为正常，5059分为轻度抑郁，6069分为中度，超过70分为重度，分数越高患者的主观感知越差，负性情绪越明显，且SAS 分界指数为50分，SDS 分界指数为53分。SCSQ含有积极和消极两方面，共20个项目，使用4分制评分法，其中12个项目为积极应对，8个项目为消极应对。BPRS包含忧郁、缺乏活力、