اثربخشی برنامۀ بازگشت به اجتماع بر تبعیت از درمان در افراد مبتلا به اسکیزوفرنیا

نوع مقاله : مقاله پژوهشی

نویسندگان

1 دانشجوی دکترای روان‌شناسی عمومی، دانشگاه علوم وتحقیقات، تهران، ایران

2 دانشیار گروه روان‌شناسی، دانشگاه الزهرا، تهران، ایران (نویسنده مسئول)

3 استادیار گروه روان‌شناسی، دانشگاه خوارزمی، تهران، ایران

10.22054/jcps.2020.43911.2159

چکیده

مقدمه:گرچه عدم تبعیت در میان همه شاخه های پزشکی شایع است،اختلالات روانپریشی با چالش بییشتری در برابر این مساله مواجه است که خطر آن را افزایش می دهد.پژوهش حاضر با هدف بررسی اثر بخشی برنامۀ بازگشت به اجتماع بر تبعیت از درمان در بیماران مبتلا به اسکیزوفرنیا انجام شد.
روش:جامعه آماری این پژوهش را کلیۀ بیماران مبتلا به اسکیزوفرنیای بستری در مراکز توانبخشی شهر تهران تشکیل دادند. با استفاده از روش نمونه گیری در دسترس و انتصاب تصادفی با احتساب معیارهای ورود و خروج از نمونه،نمونه ای به حجم 40 بیمار انتخاب و در گروه آزمایش(20 نفر) و کنترل(20 نفر) جایگزین شدند.در ابتدای پژوهش دو گروه از نظر متغیرهای سن و تحصیلات یکسان سازی شدند. گروه آزمایش به مدت 16 جلسه تحت آموزش برنامۀ بازگشت به اجتماع ،دو جلسه در هفته،قرار گرفت.آزمودنیهای گروه های ‌ آزمایش و کنترل در مرحله پیش‌آزمون، پس‌آزمون و پیگیری به پرسشنامۀ تبعیت از درمان موریسکی پاسخ دادند.
یافته ها:جهت تحلیل داده ها به دلیل نرمال نبودن داده ها و عدم رعایت مفروضه شیب رگرسیون،از آزمون u- مان ویتنی استفاده شدو یافته ها نشان دادند که بیماران گروه بازگشت به اجتماع در مقایسه با گروه کنترل پس از اجرای برنامه تفاوت معنی دار نشان دادند (10.500:U)،اما پس از دو ماه پیگیری، در نمره تبعیت از درمان( 70.500:U)،دو گروه تفاوت معنی دار مشاهده نشد.
نتیجه گیری:علی رغم محدودیتهای موجود، با توجه به نتایج به دست آمده مبنی بر اثربخشی برنامۀ بازگشت به اجتماع بر بهبود تبعیت از درمان در افراد مبتلا به اسکیزوفرنیا ،اجرای این برنامه به منظور توانمند سازی بیماران در مدیریت بیماری و کاهش عود پیشنهاد می شود.

کلیدواژه‌ها


عنوان مقاله [English]

The Effect of Community Re-entry program(CRP) on Compliance of patients with Schizophrenia

نویسندگان [English]

  • zohreh parsa 1
  • shokouh-Alsadat banijamali 2
  • Gholamreza Saramiforushani 3
1 PhD Candidate of General Psychology at Islamic Azad University Science and Research Branch
2 Associate Professor of Psychology, Alzahra University, Tehran, Iran (Corresponding Author)
3 Assistant Professor of Psychology, Kharazmi University, Tehran, Iran
چکیده [English]

Introduction: Although compliance is widespread across all medical disciplines, psychiatric disorders face the greatest challenge of increasing their risk. The purpose of this study was to investigate the effectiveness of community reentry program on compliance to treatment in patients with schizophrenia.
Methods: The statistical population of this study was all of schizophrenia patients admitted to rehabilitation centers in Tehran. Using random sampling method and random appointment with taking and exit criteria from the sample, a sample of 40 patients was selected and in the experimental group (20 persons) and control group (20 persons) were selected. In the beginning of the study, two groups of The views of age and education variables were identical. The experimental group was trained for 16 sessions, under the two-weekly community re-entry program. Subjects in the experimental and control groups responded to the Morisky treatment adherence questionnaires in the pre-test and post-test and follow up stages.
Results: To analyze the data, the u Mann whitney test was used and the findings showed that the patients in the group the community re-entry program showed a significant difference) U:10.500), compared to the control group after the implementation of the program, but after two months of follow up, there was no significant difference (U:70.500), in follow up score between the two groups.
Conclusion: Despite the current limitations, according to the results obtained on effectiveness of the community Re-entry program on improving compliance to treatment for people with schizophrenia, implementation of this program is suggested to empower patients to manage disease and reduce relapse.
the implementation of community re-entry programs is recommended for patient empowerment and reduce of relapse.

کلیدواژه‌ها [English]

  • Community re-entry program
  • Schizophrenia
  • Compliance
  • Empowerment
  • relapse
امینی خواه، معصوم؛ اسکندری، حسین؛ فلسفی نژاد، محمدرضا؛ برجعلی، احمد و پزشک، شهلا. (1394). خود و اسکیزوفرنی (مطالعه مورد پژوهی). مجله مطالعات بالینی دانشگاه علامه، (21)،202-225.
سبحانی، مرضیه، مرادی، علی‌رضا، علی بیگی، ندا، دولت شاهی، بهروز. (1389). اثربخشی درمان شناختی –رفتاری در کاهش علائم و بهبود عملکرد بیماران مبتلا به اسکیزوفرنیا. مجله مطالعات بالینی دانشگاه علامه، 1(1)، 101-128.
طاهرخانی، حمید، جلالی ندوشن، امیرحسین. (1393). برنامه بازگشت به اجتماع (CRP). تهران: انتشارات ارجمند.
کوشیار، هادی، شوروزی، مریم.، دلیر، زهرا.، حسینی، مسعود. (1392). بررسی رابطه سواد سلامت با تبعیت از رژیم‌درمانی و کیفیت زندگی مرتبط با سلامت در سالمندان مبتلابه دیابت ساکن جامعه. مجلهدانشگاهعلومپزشکیمازندران، 23 (1)،14-34.
Acosta, F., Bosch, E., Sarmiento, G., Juanes,N., Caballero-Hidalgo, A., Mayans, T. (2009). Evaluation of noncompliance in schizophrenia patients using electronic monitoring (MEMS) and its relationship to sociodemographic, clinical and psychopathological variables. Schizophrenia Research journal, 107: 213–217.
Amha, T., Dagim, A., Gebremedhin, S., Adissu, A. (2015). Factors Associated with Medication Adherence among Patients with Schizophrenia in Mekelle, Northern Ethiopia. Tadele Eticha Adissu Alemayehu, (10)3.
APA – American Psychiatric Association.Practice. (2004). Guideline for the Treatment of Patients with Schizophrenia.
Ascher-Svanum, H. (2006). A prospective study of risk factors for nonadherence with antipsychotic medication in the treatment of schizophrenia. J Clin Psychiatry, 67, 1114–1123.
Arslantas, H.., Sevinçok, L., Uygur, B., Balci, V., Adana, F. (2009). Shizofreni hastalarinin bakim vericilerineyapilan psiko-egitimin hastalardaki klinik gidise vebakim vericilerin duygu disavurumu düzeylerine olanetkisi.. Adnan Mender.
Armijo,J., Mendez,E., Morales, R., Schilling,S., Castro, A., Alvarado, R., et al. (2013). Efficacy of community treatments for schizophrenia and other psychotic disorders: a literature review. Front Psychiatry.116.es Universitesi Tip Fakultesi Dergisi, 10, 3-10.
Ayse, O., Asi Karakas, S., Sahin Altun, Ö., and Selvi, Y. (2017). The Effect of the Social and Independent Living Skills,the Community Re-entry Program Application for Patientswith Schizophrenia on their Functional Remission and Drug Adherence. Ethno Med, 11(3), 233-238.
Barkhof, C.J., Meijer, L.M.J., Sonneville, D.H., Linszen, L., Haan,A. (2012). Interventions to improve adherence to antipsychotic medication in patientswith schizophrenia–A review of the past decadea 10 E. Barkhof et al. European Psychiatry, (27), 9–18.
Bilge, A., Ekitli, GB., Embel, N., Kaya, F.G., Kalkan Turan,HS., Kaygi Ogulluk,M.) 2016(.Toplum ruh sagligimerkezi’ndeki sizofreni hastalarina uygulanan öncübelirtileri tanima ve bas etme egitiminin içgörü düzeyive yasam kalitesine etkisi. Uluslar Arasi HakemliHemsirelik Arastirmalari Dergisi, 7, 52-68.
Chien, WT., Leung, SF. )2013(.A controlled trial of a needsbased,nurse-led psychoeducation program for Chinesepatients with first-on setmental disorders: 6month followup. Nursing Practice, 19, 3-13.
Deveci,, Esen-danasi, A., Yurtsever, F., Deniz, F., Gurlek-Yuksel. Ebru. ( 2008).The Eff ects of Psychosocial Skills Training on Symptomatology,Insight, Quality of Life, and Suicide Probability inSchizophrenia, Turkish Journal of Psychiatry,19(3),1-8.
John, M,. Taishiro,K,.and Correll, Ch. (2013). Non-adherence to medication in patients with psychotic disorders, epidemiology, contributing factors and management strategies. World Psychiatry,12(3), 216–226.
Kaplan S. (2007). Synopsis of Psychiatry behavoral Sciences Clinical Psychiatry. New York: William and Willkins.
 Kopelowicz, A., Kopelowicz, R., Liberman, P., and Zarate, R. ( 2006 ). Recent Advances in Social Skills Training for SchizophreniaSchizophr Bull,32(1), 12–23.
  Liberman,P., and Zarate,R. ( 2006 ). Recent Advances in Social Skills Training for Schizophrenia.Schizophr Bull,32(1), 12–23.
Kumar, B., & Singh, A. R. (2015). Efficacy of Social Skills Training for the Persons with Chronic Schizophrenia. The Qualitative Report, 20(5), 660-696.
Liberman, RP., Wallace, CJ., Blackwell, G,. Kopelowicz, A., Vaccaro, JV., Mintz, J.)2005(. Skills training versus psychosocial occupational therapy for persons with persistent schizophrenia. Am J Psychiatry,155(8),1087-91.
Lin, E,. Ching-Lan,Ch., Chin, H., Wen-Chuan,L., Mei-Feng,Sh, Shujen,Mueser, Kim, T.,Huang, Shi-Chi,W., Hong-Song. ( 2013).A randomized controlled trial of an adapted Illness Management and Recovery program for people with schizophrenia awaiting discharge from a psychiatric hospital.Psychiatric.Rehabilitation Journal, 36(4), 243-249.
Melo-Dias, C. (2015). Psychosocial rehabilitation: The community re-entry program (CREP) in psychiatric inpatient settings, systematic review. Am J Nurs. 4(2-1):51-9.
Mortan, OS,. Sütcü, ST. (2012). Sizofreni ve diger psikotikbozukluklarda bilissel-davranisçi grup terapisisistematikbir gözden geçirme. Türk Psikiyatri Dergisi,23, 206-218.
Morisky, DE., Ang, A., Krousel-Wood, M., Ward, HJ.)2008(.Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich). 10(5),348-54.
Naoki, K., Nobuo, A, Emi I. (2003). Randomized controlled trial on effectiveness of the community re-entry program to inpatients with schizophrenia spectrum disorder. centering around acquisition of illness self-management knowledge,105(12),1514-31.
Olson, M., Marcus, S., Wilk, J., West, J. (2006). Awareness of illness and nonadherence to antipsychotic medications among persons with schizophrenia. Psychiatr Serv, 57, 205–211.
Ruzanna,Z., Marhani,M., Parveen, K., Cheah,YC. (2010). Does Psychoeducation Improve Insight of Patients with Schizophrenia,Malaysian. journal of Psychiatry E journal,10(2).
Sato, S., Ikebuchi, E., Anzai,N., Inoue, S. (2012). Effects of psychosocial program for preparing long-term hospitalized patients with schizophrenia for discharge from hospital: randomized controlled trial. Psychiatry Clin Neurosci,66(6),474-81.
Sönmez,S. (2009). Investigating the Effects of PsychoeducationGroup Studies on Positive and NegativeSymptoms, Social Functioning, Disability, Insight and Quality of Life in Patients with Schizophrenia.Ministry of Health Bakirköy Prof. Dr. Mazhar Osman Mental Health and Neurological DisordersEducation and Research Hospital 2. Expertise Thesis.Istanbul, Department of Psychiatry.
Taylor & Francis.)2004. (Psychosocial skills training on social functioningand quality of life in the treatment of schizophrenia:a controlled study in Turkey. International Journal of Psychiatry in Clinical Practice, 8, 1-7.
Thieda, P., Beard,S., Richter, A., Kane,J. (2003 ). Aeconomic review of compliance with medication therapy in the treatment of schizophrenia. Psychiatr Serv, 54(4),508-16.Velligan, D., Weiden, P,.Sajatovic, M., Scott, J., Carpenter, D., Ross, R., et al. (2009).The expert consensus guideline series: adherence problems in patients with serious and persistent mental illness. J Clin Psychiatry, 70(4), 1–46.
Velligan, D., Weiden, P., Sajatovic., M, Scott., J., Carpente., D., Ross, R., et al. (2009). The expert consensus guideline series adherence problems in patients with serious and persistent mental illness. J Clin Psychiatry, 70(4), 1–46.
Yilmaz, S. (2004). Drug Side Effects and Drug Compliance in Psychiatric Patients. Master Thesis, Unpublished. Istanbul: Istanbul University Institute of Health Sciences.