社區中精神分裂症病患的社會技能訓練

Social Skill Training for Schizophrenic Patients Living in the Community

林靜蘭(Esther Ching-Lan Lin) ； 熊秉荃(Ping-Chuan Hsiung)

《台灣精神醫學》 19卷3期 (2005/09) Pp. 192-203

https://doi.org/10.29478/TJP.200509.0004

摘要

「社會技能訓練(social skill training)」長久以來被證實可協助精神疾病患者發展合適的生活技能，並促進社會適應。本文旨在以系統性文獻回顧描述與分析過去十年間「社會技能訓練」應用於社區精神分裂症病患的研究趨勢與成效。文獻回顧結果顯示：(1)「社會技能訓練」的治療效益包括改善精神症狀、再發率、社會功能與生活品質等；(2)治療內容包括溝通、生活安排、金錢管理、症狀因應與服藥管理等技能訓練，自1996年後開始涵蓋藥物、症狀與疾病管理的層面；治療期介於3至24個月；(3)治療者專業背景包括心理師、職能治療師、護理師及技術人員；(4)對象多為男性、青壯年齡層、精神症狀穩定、合併低劑量藥物治療、無顯著認知障礙者；(5)研究設計多有對照組，50%隨機選樣、50%有評值持續性效果。總結而言，近十年間「社會技能訓練」所經歷的變革包括：對象由住院病患擴展為社區病患、治療策略由僅強調行為治療取向增加認知導向策略、訓練內容亦由「行為」跨越至「認知」層次、從「社交技巧」延伸至「疾病因應」層面；而對社區精神分裂症病患的治療效益以改善社會功能最為顯著，但在改善精神症狀與持續性效果方面仍待更多研究驗證；本文建議未來研究宜朝向自然情境與持續性效益的測試。

關鍵字

社會技能訓練 ； 系統性文獻回顧 ； 社區精神分裂症病患

並列摘要

Social skill training (SST) has been broadly applied in mentally ill patients. This article systematically reviews the application of SST in patients with schizophrenia living in community over the last decade. SST has been shown to be effective in improving psychotic symptoms, social function, quality of life and to decreasing rates of rehospitalization. The training focuses on communication, living, financial, symptoms and medication management. Interventions in studies performed in the recent decade ranged from 3 to 24 months and were conducted by psychologists, occupational therapists, nurses, or technicians. Our review found that most previous studies included primarily middle-aged males with stable condition under treatment with low-dose anti-psychotics. What % of the studies were controlled, 50% were randomized, and 50% evaluated long- term effects. Studies of SST in the recent decade have primarily involved outpatients, and have focused on cognitive components of patients and have expanding training aspects to include illness management. All SST studies have shown improvement in social function. Further longitudinal study in community settings is needed to determine whether SST can improve psychotic symptoms and to determine its long term effects.

並列關鍵字

social skill training ； systematic review ； schizophrenia ； living community resident

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