統合失調症の障害認識を改善するためのプログラムの効果への非定型抗精神病薬の影響

Effects of Atypical Antipsychotics in the Program Improving Insight into Schizophrenia

抄録

　統合失調症の障害認識を改善するためのプログラムの効果への非定型抗精神病薬の影響を検証した。対象は統合失調症23名で，薬物療法の主剤が非定型抗精神病薬である介入・非定型薬群(7名)，介入・定型薬群(6名)，非介入・非定型薬群(10名)の3群に分けた。介入前後，12か月後に評価を行った。プログラムは合計20回の心理教育および社会生活技能訓練である。社会的場面の認識能力と全般的評価尺度(GAS)がプログラム実施による有意な効果を示した。数唱が非定型薬群で有意な改善をみた。3群による比較では，社会的場面の認識能力は介入・非定型薬群のみが有意に改善していた。GAS改善と場面認識の改善とは有意な相関を示した。

　Purpose：To clarify effects of atypical antipsychotics in a the program improving insight into schizophrenia

　Subjects：Twenty-three outpatients diagnosed with schizophrenia(ICD-10)agreed to attend a20-session program. They were divided into 3 groups：Intervention ＆ Atypical Antipsychotics(n＝7), Intervention ＆ Typical Antipsychotics(n＝6), Non-intervention ＆ Atypical Antipsychotics(n＝10). The atypical(typical)antipsychotics group was made up of patients for whom 70％ of their total medication was atypical(typical)antipsychotics. The average age, year of onset, total years of education and total dose of medication did not differ between the groups.

　Methods：GAS, BPRS, DAI-10, SQLS, DIEPSS, cognitive test batteries, role-play test, and SAI-J were evaluated at baseline, after 6 months and 12 months. The weekly 1-hour/20-session

program using social skills training and psychoeducation focused on insight into schizophrenia. Each group attended the out-patients clinic biweekly, and their medication was not changed during 12 months, as a rule. Analyses were done by one way ANOVA with co-variables of the Statistical Analysis System.

　Results：GAS significantly improved after 6 months and 12 months and the receiving skills significantly improved in the Intervention ＆ Atypical antipsychotics group as compared with the Non-intervention ＆ Atypical antipsychotics group using the one-way co-variable analysis. Attention significantly improved after 6 months in the Intervention ＆ Atypical antipsychotics group as compared with the Intervention ＆ Typical antipsychotics group using the one-way co-variable analysis. In the comparison of the 3 groups, it was found that the receiving skills significantly improved after 6 months in the Intervention ＆ Atypical antipsychotics group only. The improvement of GAS and receiving skills were correlated significantly.

　Discussion：Global functioning was improved through psychosocial intervention. Attention was improved through medication. The synergistic effect of psychosocial intervention and medication were observed as improvement of social cognition, and it was related with improvement of global functioning. There remain several limitations in this research：small number of subjects, matched pair method and not-random assignment, and small degree of improvement in total evaluation.