Published online Dec 19, 2024. doi: 10.5498/wjp.v14.i12.1947
Revised: October 20, 2024
Accepted: November 5, 2024
Published online: December 19, 2024
Processing time: 76 Days and 2.2 Hours
The intervention value of a drug-psycho-social-skill model on medication comp
To explore the intervention value of a drug-psycho-social-skill model on medica
Overall, 98 out-patients and in-patients with chronic schizophrenia treated in our hospital from February 2022 to January 2023 were included and randomly divi
After the intervention, the MMSE and MoCA scores improved in both groups. MoCA scores in the study group (26.58 ± 3.21) were significantly (P < 0.05) higher than those in the control group (24.68 ± 3.02), MMSE scores were not significantly higher. Post-intervention, positive and negative symptom scores improved in both groups, and the positive and negative symptom scores in the study group [(12.01 ± 2.58) and (32.51 ± 2.11)] were significantly (P < 0.05) different than those in the control group [(14.54 ± 2.33) and (33.74 ± 2.55)]. Post-intervention, insight and treatment attitudes questionnaire scores of both groups were improved and compared with the control group (7.97 ± 3.02), the study group (13.56 ± 6.35) had significantly (P < 0.05) higher scores. Post-intervention, the MATRICS consensus cognitive battery score of both groups was improved and compared with the control group (38.44 ± 6.23), the score of the study group was significantly (P < 0.05) increased (43.51 ± 6.01). Post-intervention, the PSP score of the study group (78.38 ± 6.63) was significantly (P < 0.05) higher than that of the control group (74.52 ± 7.01). During the intervention period, the incidence of adverse reactions in the study group was 6.25%, not significantly different from that in the control group (8.33%). During the intervention, both groups experienced adverse reactions, with no significant difference between groups (P > 0.05).
The comprehensive intervention model based on drug-psychology-society-skills has obvious intervention effects on patients with chronic schizophrenia, which improves their cognitive ability and reduces their positive and negative symptoms. Simultaneously, it improves the self-knowledge of patients, improves their attitude toward treatment, effectively promotes the recovery of patients' social functions, and is safe. Therefore, it is worthy of being vigorously promoted and widely used in clinics.
Core Tip: The comprehensive intervention model based on drug-psychology-society-skills has obvious intervention effect on patients with chronic schizophrenia, which not only improves the cognitive ability of patients, but also reduces the positive and negative symptoms of patients.
- Citation: Wang HJ, Chen W, Yan XL, Huang QY, Xu WD. Effect of comprehensive intervention model based on drug-psychology-society-skills on medication compliance and cognitive ability of chronic schizophrenia patients. World J Psychiatry 2024; 14(12): 1947-1955
- URL: https://www.wjgnet.com/2220-3206/full/v14/i12/1947.htm
- DOI: https://dx.doi.org/10.5498/wjp.v14.i12.1947
Chronic schizophrenia, a disease in the field of mental health, is characterized by apathy, lack of motivation, and other negative symptoms[1]. With the gradual extension of the course of the disease, patients’ cognitive ability is impaired to some extent, which affects their mental health and adversely affects their quality of life[2]. In China, patients with schizophrenia are treated centrally and managed in a closed manner. However, patients with schizophrenia generally have poor medication compliance owing to a lack of correct understanding of their own diseases and treatments, which leads to patients’ unwillingness to cooperate, thus causing treatment difficulties[3]. Simultaneously, poor medication comp
In this study, 98 patients with chronic schizophrenia who were treated at our hospital between February 2022 and January 2023 were selected as research subjects, and the study was approved by the ethics committee of the hospital. Inclusion criteria: (1) Patients satisfying the diagnostic criteria of the international classification of diseases[9], 10th edition, and diagnosed as chronic schizophrenia by psychiatrists; (2) Age ≥ 18 years old, regardless of sex or education level; (3) Patient should be in a relatively stable period of the disease; (4) Have certain cognitive function, and be able to under
Among the 48 patients in the control group, the ratio of men to women was 27:21. The age range was 33–45 years, with an average age of (40.21 ± 4.32) years. The course of disease is 5-10 years, with an average of 7 ± 2.5 years and an average of (3.36 ± 0.48) years. Of the 48 patients, 7, 14, and 9 had major depression, schizophrenia, and bipolar disorder, respectively.
Among the 48 patients in the research group, the men-to-women ratio was 29:19. The age range was 34-44 years, with an average age of (39.12 ± 4.54) years. The course of the disease was 5-9 years with an average of 6.5 ± 3.0 years. There was no significant difference in the clinical data between the two groups, therefore, a targeted clinical comparison could be made (P > 0.05).
Control group: Intervention with second-generation antipsychotics. The dosage of most clozapine tablets was 200-600 mg/day, the dosage of quetiapine combined with quetiapine was 400-600 mg/day, the dosage of risperidone tablets was 4-6 mg/day, or the dosage of ziprasidone tablets was 80-120 mg/day. The dosage was individualized, considering the effective dosage and safe blood concentration range. Further, patients adherence to the dosage schedule (timing and quantity) was supervised, their families were guided on how to take drugs accurately, any changes in patients’ conditions were identified, community doctors were consulted on time under abnormal circumstances, patients’ possession of drugs was observed, and patients with suicidal tendencies were closely monitored.
Study group: Based on the control group, a drug-psychological-social-skill comprehensive intervention was admini
Drug intervention and drug management training: Treatment drugs and control groups. Simultaneously, the adverse reactions of drugs and basic knowledge of psychotropic drugs were explained to the patients and their families to im
Psychological intervention: Patients were supported and encouraged to help them face reality faster and live actively. According to the individual mood and ideological changes of patients, humor and positive language was used to sti
Socio-skill intervention: (1) Life skills training: Using one-to-one behavior correction guidance, patients were trained in terms of daily self-care ability such as diet, personal hygiene, dressing and grooming, 2-3 times a day, and each training time was controlled within half an hour. At the same time to actively participate in the patient to give timely encouragement and affirmation. Patients were trained in daily living activities such as shopping and washing clothes, and their family members accompanied and assisted them throughout the training process, training once or twice a day, and each time was controlled to about 15 minutes; (2) Social employment skills training: For patients with functional disabilities, based on their previous occupations, occupational therapy and systematic labor simulation training were used to carry out individualized training in combination with their individual conditions. Each training time lasted for 1 hour, twice a week. Patients were encouraged to use household work or community services accompanied by family members, and the time was also controlled at approximately 1 hour each time; (3) Emotional control training: Patients’ interests and hobbies were combined and they were encouraged to participate in recreational activities such as chess, playing ball, singing, etc., to help patients integrate into the normal life track. The patients were guided in finding appropriate ways of emotional catharsis by playing tai chi, practicing Wuqin play, etc. Additionally, basic emotional regulation skills, such as, deep breathing, appropriate physical exercise, and other ways to control emotions were taught. Psychologists conducted a psychological intervention for patients once a week, and specialists explained the general symptoms and treatment measures of schizophrenia to patients and their families, and reflect to doctors when necessary to get active treatment; and (4) Social skills training: Patients were encouraged to introduce themselves and their interests and hobbies in an appropriate way. General life events such as birthdays, dining, shopping were simulated to let patients learn how to get along with others, express their inner thoughts, and master the method of praising others and self-praise. They were also allowed to learn how to regularly carry out team cooperation games by encouraging and praising the patients in order to affirm correct behavior.
Both groups underwent intervention continuously for 3 months.
The mini mental status examination and Montreal cognitive assessment were used for joint assessment: Mini mental status examination (MMSE)[10] evaluates seven components: Language, attention, computing power, immediate memo
Positive and negative syndrome scale: Positive and negative syndrome scale (PANSS)[12] scores before and after treatment were compared between the groups. Negative symptoms mainly include poor speech, concentration defects, emotional retardation, apathy, and social withdrawal, while positive symptoms mainly include hallucinations and de
Insight and treatment attitudes questionnaire: The scale[13] has 11 questions, including the patients’ knowledge of diseases and their attitudes towards treatment. The evaluation doctor asks each question to the patient and answers and explains the question. The doctor gave a score of 0-2 based on the patient’s answers. The score 2 = completely self-aware, 1 = partially self-aware, and 0 = not self-aware. The lowest score on the questionnaire was 0 and the highest score was 22. The higher the score, the better the patient’s insight into and attitude towards treatment.
Cognitive ability scale: Before and after the intervention, patients’ cognitive ability was evaluated using the MATRICS consensus cognitive battery (MCCB)[14], which included eight subtests, including number symbol, number span, visual memory, maze, visual reproduction, verbal fluency, short-term language memory, and continuous operation, and cog
Social skills: Through the personal and social performance scale (PSP)[15], activities, personal and social relationships, self-care, and disturbing and aggressive behaviors are useful to patients in society were evaluated. The first three items are scoring standards and the fourth item is a scoring standard. The total score ranges from 0 to 100. Divided into 10 grades, 71-100 points: The patient’s social and interpersonal skills are good and only slightly affected; 31-70: There are different degrees of defects in social skills; < 30: Patient’s ability is low and needs active support or monitoring.
Adverse reactions in the two groups during the intervention period were evaluated, including extrapyramidal reac
Statistical product and service solutions 26.0 was used for data processing. The counting data obtained from the ex
Before the intervention, there were no significant differences in the MMSE and MoCA scores between the two groups (P > 0.05). After intervention, the scores of both groups significantly improved, and the MoCA score of the study group (26.58 ± 3.21) was significantly higher than that of the control group (24.68 ± 3.02), the difference was statistically significant (P < 0.05), but there was no statistically significant difference in MMSE score between the two groups (P > 0.05). See Table 1.
Group | Number of cases | MMSE score | MoCA score | ||
Before intervention | After intervention | Before intervention | After intervention | ||
Research group (n = 48) | 48 | 22.25 ± 2.47 | 27.15 ± 2.58 | 23.31 ± 2.14 | 26.58 ± 3.21a |
Control group (n = 48) | 48 | 22.33 ± 2.71 | 26.24 ± 2.36 | 23.44 ± 2.09 | 24.68 ± 3.02a |
t value | 0.151 | 1.803 | 0.301 | 2.987 | |
P value | 0.880 | 0.075 | 0.764 | 0.004 |
Before the intervention, there was no significant difference in the scores of positive symptoms and negative symptoms between the two groups (P > 0.05). After intervention, both positive and negative symptom scores were improved in the two groups, and the positive symptom scores (12.01 ± 2.58) and negative symptom scores (32.51 ± 2.11) in the study group were more significantly changed than those in the control group [(14.54 ± 2.33) and (33.74 ± 2.55)]. This difference was statistically significant (P < 0.05). See Table 2.
Group | Number of cases | Positive symptom score | Negative symptom score | ||
Before intervention | After intervention | Before intervention | After intervention | ||
Research group (n = 48) | 48 | 15.38 ± 2.45 | 12.01 ± 2.58a | 35.22 ± 2.65 | 32.51 ± 2.11a |
Control group (n = 48) | 48 | 15.66 ± 1.94 | 14.54 ± 2.33a | 35.53 ± 2.01 | 33.74 ± 2.55a |
t value | 0.621 | 5.042 | 0.646 | 2.575 | |
P value | 0.536 | 0.000 | 0.520 | 0.012 |
Before the intervention, there was no significant difference in the insight and treatment attitudes questionnaire (ITAQ) scores between the two groups (P > 0.05). After intervention, ITAQ scores of both groups were improved, and compared with control group (7.97 ± 3.02) scores, the score of study group (13.56 ± 6.35) scores was significantly increased, and the difference was statistically significant (P < 0.05). See Table 3.
Before the intervention, there was no significant difference in the MCCB scores between the two groups (P > 0.05). After intervention, the MCCB score of both groups was improved, and compared with the control group (38.44 ± 6.23), the score of the study group was significantly increased (43.51 ± 6.01), and the difference was statistically significant (P < 0.05). See Table 4.
Before the intervention, there was no significant difference in PSP scores between the two groups (P > 0.05). After intervention, the PSP score of the study group (78.38 ± 6.63) was significantly higher than that of the control group (74.52 ± 7.01), and the difference was statistically significant (P < 0.05). See Table 5.
Group | PSP | t value | P value | |
Before intervention | After intervention | |||
Research group (n = 48) | 46.79 ± 7.31 | 78.38 ± 6.63 | 22.177 | 0.000 |
Control group (n = 48) | 45.51 ± 7.26 | 74.52 ± 7.01 | 19.916 | 0.000 |
t value | 0.861 | 2.772 | ||
P value | 0.382 | 0.007 |
The incidence of adverse reactions in the study group was 6.25%, which was not significantly different from that in the control group (8.33%), P > 0.05. See Table 6.
Group | Extrapyramidal reaction | Put on weight | Elevated blood sugar | Hyperlipidemia | Incidence rate |
Research group (n = 48) | 1 (2.08) | 0 (0.00) | 0 (0.00) | 2 (4.17) | 3 (6.25) |
Control group (n = 48) | 2 (4.17) | 0 (0.00) | 0 (0.00) | 2 (4.17) | 4 (8.33) |
χ2 | 0.205 | ||||
P value | 0.36 |
The continuous prolongation of chronic schizophrenia can cause great damage to the patient’s body and mind in the long run, especially in terms of cognitive ability and social adaptability. As patients with schizophrenia easily lose confidence in treatment after long-term medication, medication compliance is an important factor in the treatment of patients with schizophrenia[16]. The main factors that affect patients’ medication compliance are a lack of cognitive ability, the importance of continuous treatment to a certain extent, and the wrong cognition of adverse drug reactions, which leads patients to refuse to take medication[17]. If patients take their medication on time, they can better control their symptoms and reduce the possibility of recurrence, thus improving their quality of life[18]. Currently, the universal free medication policy has increased medication compliance to some extent and reduced the recurrence of diseases and further agg
The MMSE and MoCA rating scales mainly evaluate patients’ cognitive function. The comprehensive intervention of drug-psychology-society-skills can reduce the interruption rate of antipsychotic drug treatment, effectively improve the patient’s disease status and quality of life and bring new hope to the treatment of chronic schizophrenia[19]. Insisting drugs are the most effective means of preventing the recurrence of chronic schizophrenia. Hattabi et al[20] reported that the combination of psychological, social, and skill intervention training based on drug treatment can reduce the recurrence rate of patients with chronic schizophrenia and restore their damaged social functions, such as life, work, and study. The results of this study showed that the MMSE score was not statistically significant, which may be related to the insensitivity of the indicators. Although chronic mental illness results in cognitive impairment, it has not yet reached the level of dementia. The MoCA score and the complete cognitive function test for schizophrenia (MCCB) in the study group were statistically higher than those in the control group, suggesting that the comprehensive intervention model of drug-psychology-society-skills has a certain positive significance for patients with chronic schizophrenia and the two scales may be more useful for evaluating cognitive impairment. The reason is that the second-generation antipsychotic drugs show high affinity for α1 and α2 receptors by acting on 5-hydroxy tryptamine (HT) 2 and D2 receptors. On the one hand, they block D2 receptors in the midbrain marginal pathway, thus changing patients’ attention[21], on the other hand, they block 5-HT2 receptors in the midbrain cortical pathway and the substantia nigra striatum pathway, improving the functions of D1 receptors in the prefrontal cortex and D2 receptors in the striatum, thus improving the cognitive function of patients with chronic schizophrenia[22]. Through psychosocial and skill interventions, patients can learn to rationally vent their emotions and relax, and correctly express their emotions and needs. Simulation training of employment skills was developed according to the patients’ own conditions to improve their ability to deal with problems and cultivate their learning habits and ability to accept new things. They must be encouraged to actively participate in social activities and naturally integrate into them[23] and foster self-affirmation, thereby helping them regain confidence in recovery and indirectly helping them improve their quality of life.
Cognitive impairment is a typical symptom in chronic schizophrenia[24]. An increase in the MMSE and MoCA scores indicates that the cognitive function of the patients has recovered to some extent. However, this study found that the scores of positive and negative symptoms in the study group were lower than those in the control group, indicating that the comprehensive drug-psychology-society-skills intervention can reduce positive and negative symptoms in patients with chronic schizophrenia. This is because clozapine can stimulate the serotonin receptor and promote dopamine release, thus increasing dopamine content in the synaptic cleft[25]. Clozapine also has an anticholinergic effect that can effectively improve the conversion efficiency of dopamine in the central nervous system and increase dopamine levels in the substantia nigra-striatum, thus strengthening dopamine nerve function and reducing cholinergic nerve function[26]. Furthermore, the drug can be taken for a long time. Training patients in society and skills, encouraging patients to communicate with others, and enhancing patients’ confidence are conducive to the improvement of the disease.
There is a positive correlation between medication compliance and insight, and the improvement of insight is related to cognitive ability. Therefore, we can infer that improving cognitive ability can improve insight, and thus improve me
This study also found that, after treatment, the PSP score of patients in the study group was significantly higher than that in the control group. The reason for this was that the mental symptoms and psychological state of patients were effectively alleviated through the control and improvement of symptoms of severe mental illness by drugs. A comprehensive treatment system was formed with the intervention of society and skills to improve the symptoms of patients more comprehensively and improve the score on the social skills scale. Furthermore, the results of this study also showed no significant difference in adverse reactions between the two groups, which may be due to individual differences in patients related to personal physique, age, and long-term medication use.
In summary, the comprehensive intervention mode based on drug-psycho-social-skills can reduce the disease state of patients with chronic schizophrenia, enhance the cognitive ability of patients, reduce the positive and negative symptoms of patients, and improve the self-knowledge of patients and their attitude toward treatment. This model provides more comprehensive support for patients and new ideas and directions for the development of the mental health field. However, this study also has some limitations: (1) The sample size of patients was small, which may affect the universality of the study results, so it is still necessary to carry out further research and observation of large samples; (2) Observation of results by means of scale statistics may cause the results to be affected by subjective factors, so the analysis of objective indicators should be added in subsequent studies; (3) Patients were not followed up, and the potential impact of comprehensive intervention on patients’ long-term life could not be clarified. Therefore, the study period should be further extended to clarify the clinical application value of comprehensive intervention; and (4) This study only observed the clinical treatment outcome of patients, and the specific mechanism of action was not clearly explained. Therefore, further research should be conducted to improve intervention mechanisms.
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