目的 深入了解自知力教育对精神分裂症患者负性情绪的影响,并进一步探索其原因,为自知力教育方式的改进和教育内容的完善提供科学依据.方法将精神分裂症患者217例随机分为教育组和对照组,两组均接受抗精神病药物系统治疗,教育组在此基础上予自知力教育8周,教育前后分别采用简明精神病评定量表(BPRS)、自知力与治疗态度问卷(ITAQ)、焦虑自评量表(SAS)、抑郁自评量表(SDS)进行评定；根据评定结果,对自知力恢复伴焦虑、抑郁的患者进行深入访谈,将获得的资料用Giorgi法分析.结果教育后BPRS评分两组间比较,差异无统计学意义(P＞0.05)；ITAQ、SAS、SDS评分教育组均明显高于对照组(P＜0.05).对11例患者深入访谈,得出患者自知力恢复后产生负性情绪的社会心理因素有:对过去病态行为及其后果的羞愧和自责心理、归属感得不到满足、深刻的病耻感、对前途的绝望感.结论 对精神分裂症患者进行自知力教育,应根据患者负性情绪状况随时调整教育内容和告知策略,并针对患者的社会心理因素给予有效的情感支持,使患者在自知力恢复的同时减轻或消除负性情绪.%Objective To investigate the effects of the insight education on negative emotions in schizophrenia patients and the influential factor,and provide a basis for improving methods and contents of the insight education. Methods Two hundred and seventeen schizophrenia patients were randomly divided into education group(n=110) and control group(n=107). Two groups received routine medical therapy and education, and education group received insight education in addition. These patients had been treated for eight weeks. The Brief Psychiatric Rating Scale (BPRS), the Insight and Treatment Attitude Questionnaire(ITAQ),Self Rating Anxiety Scale(SAS) and Self Rating Depression Scale(SDS) were used to assess the two groups before and after the education. Eleven schizophrenia patients with negative emotions were selected by purposive sampling. The data were collected by in-depth interview and analyzed by Giorgi's phenomenological procedures. Results It was found that the scores of BPRS in the two groups didn't show significant difference (P>0.05).The scores of ITAQ,SAS and SDS in the education group were higher than those in the control group(P<0.05).There existed some psychological and social factors of patients with negative emotions such as remorse and shame for the past sickness behavior and its consequences, dissatisfied sense of belonging,deep felling of stigma,hopelessness for future,and so on. Conclusion Medical staff should implement the different contents of the insight education and informed policy according to the different conditions of different patients with negative emotions,and provide them with effective emotional support to reduce the patients'negative emotions.
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