精神分裂症病人自杀风险与病耻感的关联,医学心理学论文.docx
精神分裂症病人自杀风险与病耻感的关联,医学心理学论文3 讨论 本研究发现，精神分裂症患者的感悟病耻感与自杀观念评分呈正相关，且独立于患者的抑郁异常感觉和状态与自知力水平，与Eagles等16研究结果一致，他们发现近60%有自杀史的重性精神疾病患者报告是病耻感导致了自杀危机，并提出降低病耻感是预防精神病患者自杀的重要方面。由于患者的感悟病耻感往往会对其自尊、自我效能和自自信心等产生负面影响，造成患者的社会交往回避，进一步损害患者的各项社会功能，甚至产生抑郁情绪、自杀意念及自杀行为。研究结果提示：在精神分裂症的治疗中，减轻患者的病耻感可能是一个重要的治疗目的，如运用认知行为治疗Cognitive Behavioral Therapy,CBT17改善患者对病耻感的认知与应对能力，并减轻患者对病耻感的负性体验。本研究还发现精神分裂症患者自知力评分越低，即自知力越完好，则持有自杀观念的风险越大。自知力是指对个体患有疾病、异常感觉和状态表现及治疗的意识能力。良好的自知力有利于增加药物治疗依从性，促进疾病康复，改善预后。然而，近期的一项Meta分析18显示：精神分裂症患者良好的自知力与抑郁程度呈正相关。2021年的一项研究19也显示，自知力可能是自杀的一个危险因素，当个体具备良好的自知力，可能会由于自个患有精神分裂症而对自个及将来持有负面评价，而这华而不实潜在原因来源于个体对疾病的病耻感，这与本研究结果一致。 综上所述，精神分裂症患者感悟的病耻感与自杀观念相关，提示临床工作者要关注病耻感给精神分裂症患者造成的影响，帮助患者建立自信，提高自我效能感和自尊水平，有效应对病耻感，进而降低病耻感带来的危害并促进患者社会康复20.但本调查为横断面研究，需要纵向研究进一步确定病耻感对自杀观念的负面影响。且本研究仅考虑了感悟的耻感，今后的研究可讨论内化的耻感、耻感的应对等相关因素对自杀的影响。 以下为参考文献 1Palmer BA,Pankratz VS,Bostwick JM. The lifetime risk of suicidein schizophrenia:a reexaminationJ. Arch Gen Psychiatry,2005,623 :247 - 253. 2R sch N,Corrigan PW,Powell K,et al. A stress - coping modelof mental illness stigma:II. Emotional stress responses,copingbehavior and outcomeJ. Schizophr Res,2018,1101 - 3 :65 - 71. 3Xu Z,M ller M,Heekeren K,et al. Pathways between stigmaand suicidal ideation among people at risk of psychosisJ.Schizophr Res,2021,1721 - 3 :184 - 188. 4R sch N,Angermeyer MC,Corrigan PW. Mental illness stigma:concepts,consequences,and initiatives to reduce stigmaJ. EurPsychiatry,2005,208 :529 - 539. 5Xu Z,M ller M,Heekeren K,et al. Self - labelling and stigmaas predictors of attitudes towards help - seeking among people atrisk of psychosis:1 - year follow - upJ. Eur Arch PsychiatryClin Neurosci,2021,2261 :79 - 82. 6 徐子燕，张怡，李占江，等。以被害妄想为主的精神分裂症患者自尊、应对方式及其与精神异常感觉和状态的关系J.中国健康心理学杂志，2020,212 :164 - 166. 7R sch N,Zlati A,Black G,et al. Does the stigma of mentalillness contribute to suicidalityJ. Br J Psychiatry,2020,2054 :257 - 259. 8Farrelly S,Jeffery D,R sch N,et al. The link between mentalhealth - related discrimination and suicidality:service userperspectivesJ. Psychol Med,2021,4510 :2020 - 2022. 9Durkheim 。 Suicide:astudy in sociologyM. London:Rout-ledge,1951. 10Van Orden KA,Witte TK,Cukrowicz KC,et al. The interpersonaltheory of suicideJ. Psychol Rev,2018,1172 :575 - 600. 11Pompili M,Mancinelli I,Tatarelli R. Stigma as a cause of suicideJ. Br J Psychiatry,2003,183:173 - 174. 12Tarrier N,Khan S,Cater J,et al. The subjective consequences ofsuffering a first episode psychosis:trauma and suicide behaviourJ. Soc Psychiatry Psychiatr Epidemiol,2007,421 :29 -35. 13Hamilton M. A rating scale for depressionJ. J Neurol NeurosurgPsychiatry,1960,23:56 - 62. 14 徐晖。精神分裂症患者病耻感及其与服药依从性关系的研究D.北京： 中国协和医科大学，2008. 15Ballard ED,Luckenbaugh DA,Richards EM,et al. Assessingmeasures of suicidal ideation in clinical trials with a rapid - actingantidepressantJ. J Psychiatr Res,2021,68:68 - 73. 16Eagles JM,Carson DP,Begg A,et al. Suicide prevention:astudy of patients viewsJ. Br J Psychiatry,2003,182:261 - 265. 17Griffiths KM,Carron - Arthur B,Parsons A,et al. Effectivenessof programs for reducing the stigma associated with mentaldisorders. A meta - analysis of randomized controlled trialsJ.World Psychiatry,2020,132 :161 - 175. 18Belvederi MM,Respino M,Innamorati M,et al. Is good insightassociated with depression among patients with schizophrenia?Systematicreview and meta - analysisJ. Schizophr Res,2021,1621 - 3 :234 - 247. 19Barrett EA,Mork E,Farden A,et al. The development of insightand its relationship with suicidality over one year follow - up inpatients with first episode psychosisJ. Schizophr Res,2021,1621 - 3 :97 - 102. 20 徐子燕，杨清艳，李占江。精神分裂症的认知行为治疗J.中国健康心理学杂志，2006,143 :352 - 354.
