| Objective: Schizophrenia ia a chronic, recurrent, persistent psychiatric disorder with unclear etiology. Its common onset was among teenagers and people in their peak time of life; impairing their social functions greatly. As the lack of understanding of this disease, weighing mental pressure and conventional prejudice against psychiatric diseases; the spouses of patients have been experiencing lots of mental problems as well, such as anxiety and depression, which, therefore, impacts their behaviour and social functions. The mood and mental status of the spouses can also influence the patients, and consequently the control of the disease and the rehabilitation of social functions. Patients on rehabilitation stage are usually with better social function, some of who even have senses of family responsibilities which are likely to cause self-guilty and unpreferred impact on patients’ mental health. In this study, both patients on rehabilitation of paranoid schizophrenia and their spouses were supposed to experience Discontinuous Naikan Cognitive Therapy (DNCT), with more emphasis on their marital status; which provides a new approach to improve the quality of lives of healing patients with paranoid schizophrenia and their family members.Methods: From January to August2012, Dept. Combined Medicine of Tianjin Anding Hospital,60patients on rehabilitation of paranoid schizophrenia and their spouses who met the inclusion criteria were enrolled as research subjects in this study, including both male and female patients, aging from22to65, with education background higher than junior high school. Every patient enrolled in this study were participated voluntarily or with the consent from his legal guardian. Every subject took his medication regularly. No change of medication was permitted since1month before this study for all subjects.60subjects were also divided into two groups: the study group (n=30) who experienced Naikan Cognitive Therapy (NCT) for4weeks along with their spouses separately,3hours everyday; the control group (n=30) received family psychotherapy in a similar room during the same time. Symptom Checklist90(SCL-90), Positive and Negative Syndrome (PANSS), Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), General Well-being Schedule (GWB), ENRICH, Family Adaptability and Cohesion Scale (FACES II-CV) were applied to assess subjects’ mental status and their subjective feeling about family life and marriage, at start and endpoint of this study as well as at a12-week follow-up. The patients’ spouses were also assessed with General Well-being Schedule (GWB), ENRICH, and FACES Ⅱ-CV at the same time.Results:60patients and their spouses completed the study.30cases in study group and30cases in control group continued into result analysis. No significant difference in general social information, medication and evaluation items was found between these two groups before intervention.①fter intervention, among the study group, PANSS the total score turned to be lower the before, every factor of PANSS scored lower than before; the differences were statistically significant (P<0.01). In the control group, however, PANSS positive symptom factor, negative symptom factor, thought disorder factor, activating factor and paranoid factor scored lower, with statistic significance(P<0.05), than before, while depression factor was higher than before, also with statistic significance (P<0.01). At the endpoint of this study, PANSS total score, along with scores of negative symptom factor and general psychopathology factor, was lower than those of the control group (P<0.05), similar pattern was also seen among subjects from both study group and control group; except PANSS negative symptom factor and paranoid factor from control group bounced back at12-week follow-up. PANSS total score, along with scores of positive symptom factor, negative symptom factor, general psychopathology factor, thought disorder factor, activating factor, paranoid and depression factor was lower than those of the control group (P<0.05).②After intervention, in the study group, SCL-90and each of its factors scored lower than before, with statistic significance (P<0.01); in the control group, SCL-90total score, scores of somatization obsessive-compulsive factor, interpersonal sensitivity, photic anxiety, psychoticism, turned to be lower (P<0.05), while those of anxiety and paranoid ideation factor were higher than before (P<0.01). At endpoint of this study, PANSS total score, scores of somatization, obsessive-compulsive factor, interpersonal sensitivity, depression, hostility and paranoid ideation from the study were lower than those of the control group (P<0.05). At12-week follow-up, same pattern was observed in the study group; while only SCL-90total score, somatization, obsessive-compulsive factor, photic anxiety, and psychoticism scored lower than before the intervention in control group (P<0.05), and the anxiety was even higher than before in control group (P<0.05). All the factors in the study group that scored lower than those of the control group remained the similar pattern at12-week follow-up assessment.③Scores of SAS, SDS turned to be lower than those before the intervention in both the study group and the control group (P<0.01, P<0.01), same pattern remained the same at12-week follow-up assessment (P<0.01, P<0.01). SAS and SDS from the study group scored lower than those from the control group at endpoint of this study and at12-week follow-up (P<0.01, P<0.01).④After intervention, in the study group, FACES Ⅱ-CV actual intimacy and actual adaptability did improve with statistical significance (P<0.01); while unsatisfaction of the actual intimacy, as well as the unsatisfaction of the actual adaptability, was lower than before (P<0.01, P<0.01). In the control group, the actual intimacy scored higher higher than before the intervention (P<0.01), with less unsatisfaction of intimacy (P<0.01); while the actual adaptability worsened (P<0.01) with more unsatisfaction of adaptability (P<0.01). At12-week follow-up, in the study group, the actual intimacy and expected intimacy scored higher than before (P<0.01, P<0.05), and the unsatisfaction of intimacy was less than before (P<0.01). The actual adaptability of the study group scored higher than earlier (P<0.01), and the unsatisfaction fo adaptability was less at the follow-up (P<0.01). At the follow-up, in the control group, the actual intimacy scored lower than before (P<0.01), while the actual and expected adaptability scored higher (P<0.01). The actual intimacy and adaptability from the study group turned to be higher than those from the control group (P<0.05, P<0.05), with less unsatisfaction of both intimacy and adaptability (P<0.01, P<0.01), at the endpoint of this study. The pattern remains at the12-week follow-up.⑤GWB from both the study group and the control group scored higher at the endpoint (P<0.01,P<0.01). So it was almost the same at12-week follow-up (P<0.01,P<0.05). GWB from the study group did score higher than that from the control group at the endpoint and at12-week follow-up (P<0.01, P<0.01).⑥After intervention, in the study group, ENRICH total score, and scores of all factors, was higher than before, with statistical significance. In the control group, ENRICH score of character equality was higher than before (P<0.05); while total score, scores of excessive idealization, marital satisfaction, character compatibility, communication between spouses, economic arrangement and children’s marriage were lower than before with statistical significance (P<0.05). At follow-up, same pattern was witnessed in the study group. In the control group, belief consistence factor scored higher than before (P<0.05), while total score, scores of excessive idealization, marital satisfaction, character compatibility, economic arrangement and relationship with family members, wan lower than before (P<0.05);. At endpoint of this study, ENRICH total score, scores of excessive idealization, character compatibility, conflict solution, economic arrangement and leisure activities were higher than those of control group (P<0.05); at the follow-up, other than the factors mentioned above, communication between spouses, sex life, relationship with family members and character equality from the study group scored higher than those from control group (P<0.05).⑦At endpoint of this study,among spouses of patients from the study group, FACES Ⅱ-CV actual intimacy and adaptability scored higher than spouses from control group (P<0.05); and remained so at the follow-up (P<0.05).⑧GWB from spouses of patients in the study group was also higher than that of spouses in the control group at the endpoint (P<0.01); it was the same at the follow-up also.⑨After intervention, among spouses of patients from the study group, ENRICH total score, scores of marital satisfaction, character compatibility, communication between spouses, conflict solution, economic arrangement, leisure activities, sex life and character equality were higher than those of spouses from the control group (P<0.05), which remained same at the follow-up (P<0.05), along with excessive idealization and relationship between family members factors sharing the similar pattern (P<0.05).Conclusions: Under regular medication, with the help of Naikan Cognitive Therapy (NCT);①the mental status of patients on rehabilitation of paranoid schizophrenia had been much improved, which had a positive impact on rehabilitation itself as well;②the anxiety and depression the patients used to have had been much alleviated;③the subjective feeling of happiness and the marital status had been much improved.④After systematic NCT, the subjective feeling of happiness and the marital status of the spouses of patients had been much improved, which was also helpful to the rehabilitation of the patients.⑤At12-week follow-up, the mental status, subjective feeling of happiness and the marital status of both patients and their spouses who experienced NCT turned to be much better than those who experienced family psychotherapy, indicating that NCT is able to provide a consistent therapeutic effects. A future study with more subjects and longer follow-up should be encouraged to further evaluate the consistent therapeutic effects of NCT on patients on rehabilitation of paranoid schizophrenia. |
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