Бауманн У., Перре М. - Клиническая психология
.pdf.
- :
: 1) — Chlorpromazin ( ), 2) — Thioridazin ( ), 3) — Fluphenazin (
); 4) .
; .
-:
). — 6 .
-: 417 ;
; — 28 ; 60%
— .
-— : ):
|
|
|
|
|
(n = 296) |
(n = 111) |
|
|
9 (3%) |
1 |
(1%) |
|
11 (4%) |
|
0 |
|
7 (2%) |
36 |
(32%) |
|
269 |
|
74 |
-:
— Inpatient Multidimensional Psychiatric Scale (IMPS; 14
), — Burduck Ward Behavior Rating Scale
(WBRS; 7 ).
:
-— ):
) ;) .
|
|
|
|
|
) |
|
25% |
0 |
|
20% |
5% |
|
25% |
20% |
|
30% |
75% |
- ( ) 6- :
) ;) .
|
|
|
|
|
) |
|
5% |
16% |
|
10% |
30% |
|
15% |
16% |
|
20% |
20% |
|
50% |
18% |
- — Inpatient Multidimensional Psychiatric Scale (IMPS), — Burduck Ward Behavior Rating Scale (WBRS):
) ;) ( ),
, 13 21 (WBRS: , , ; IMPS:
, , , , ,
, , , ).
---
(National Institute of Mental Health; NIMH) (Cole, 1964)
. , ,
.
,
, , , .
« »,
, , ,
.
100 ,
(Davis, Barter & Kane, 1989; Dixon, Lehman & Levine, 1995):
75% ,
— 25%. ,
,
. , , ,
,
.
.
,
. 3% (Cole, 1964)
. ,
, ( . Tornatore, Sramek, Okeya & Pi, 1991).
, , , ,
, (Cole, 1964);
, , .
. ).
— (Haloperidol) (Fluphenazin).
( , (Clozapin), (Olanzapin)
(Risperidon)), ;
(Buchanan, 1995; Umbricht & Kane, 1995).
, , ,
.
, . ,
( ., , Linden, 1987; Windgassen, 1989; Weiden, Dixon, Frances, Appelbaum, Haas & Rapkin, 1991).
2.2.
, ( )
.
. ,
, , :
,
.
, , (Ciompi, 1986)
, . 35.3.1;
.
35.3.1. (Ciompi, 1986)
1), ,
.
.
3), .
4), ,
,
.
5), .
6).
7)- .
,
,
, .
(Matthews, Roper, Mosher & Menn, 1979).
;
.
22 ,
(Ciompi et al., 1993).
, ,
. , ,
60% , ;
185 , ,
. , , , 1) ,
, , ; 2)
, ,
3),
.
, ,
, — .
,
, . ,
30 , . , , ,
(Kellam, Goldberg, Schooler, Berman & Shmelzer, 1967) 27
,
(Cole, 1964), .
,
.
,
. « »
(Schooler & Spohn, 1982) , ,
,
, ,
.
, « ». 60- ,
( . : Stanton et al., 1984; Scott & Dixon, 1995b). , « »
( ),
, , ,
(«reality oriented») ( , Gunderson et al., 1984).
. (Wunderlich, Wiedemann & Buchkremer, 1996)
31 ,
: ( « » (Expressed Emotion),. ), ( , . ), -
, ( ,
), , , ,
, ,
. .
», , ,
, , , ,
.
( ) ,
, . .
,
,
, , .
. ,
59% , —
41%. ,
,
.
( . 35.3.1).
|
k |
N |
rg |
r |
s |
|
6 |
360 |
+0,28 |
+0,32 |
0,114 |
|
6 |
210 |
+0,28 |
+0,28 |
0,064 |
|
1 |
37 |
+0,27 |
|
|
|
|
|
|
|
|
|
6 |
276 |
+0,20 |
+0,25 |
0,124 |
|
1 |
82 |
+0,19 |
|
|
|
3 |
527 |
+0,12 |
+0,13 |
0,058 |
, |
4 |
383 |
+0,11 |
+0,14 |
0,028 |
|
|
|
|
|
|
|
4 |
361 |
+0,08 |
+0,15 |
0,131 |
|
1 |
28 |
+0,02 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
k = ; N = ; rg = ; r =
; s =
. 35.3.1. :
( Wunderlich, 1996)
3. ,
, ( .
: An der Heiden, 1996; Möller & Von Zerssen, 1995), ,
,
.
,
, .
. ,
,
(An der Heiden et al., 1995; Harding, Brooks, Ashikaga, Strauss & Breier,
1987).
, ,
, , .
, ,
(Lehman, 1995),
, .
3.1.
44 , ,
. ,
, 70% , ,
23% (Dixon, Lehman & Levine, 1995). ,
, , , , , ,
.
6-24
(75%) (Hirsch & Barnes, 1995, S. 458).
, ,
.
.
, ,
. , ,
, , 15% ,
, 1% (Kissling, 1991; Jeste & Caliguri, 1993).
,
.
,
( Hirsch & Barnes, 1995).
:
( , , ,
) ( . : Herz & Lamberti, 1995; Norman & Malla, 1995).
,
, (Jolley & Hirsch, 1990; Schooler, 1991; Hahlweg, Dürr & Müller, 1995).
, ,
.
.
3.2.
(Bleuler, 1923) ,
, : « .
, , ,
, . ,
, ; ,
».
3.2.1.
XX
, (Hegarty, Baldessarini, Tohen, Waternaux
& Oepen, 1994), 30-
(Wing, 1982).
,
5-10%.
, .
, , ,
, ,
. (Wing & Brown, 1970)
, , ,
1) ,
; 2)
.
(
, , )
. ,
( )
. , , ,
, ,
.
.
(Schooler & Spohn, 1982) ,
, ,
.
: , ,
, , 3%
, 19% ,
. :
; , , ,
, ; ;
.
.
; 41 , , 34
. ,
,
:
! . ,
(
),
.
(Paul & Lentz, 1977) 84
, ( 17 ).
,
. , ,
:
, .
.
«
» («Sozialen-Lern-Programm») , —
» («Milieu-Programm»),
(Therapeutische Gemeinschaft).
. « »
, , , ,
.
»
; 24 , 16 — 13 —
.
,
( . Cohen, Florin, Grusche, Meyer-Osterkamp & Sell, 1973). , ,
, , ,
, . ,
,
. ,
,
, .
3.2.2.
,
— (Wing & Brown, 1970; Wing, 1982).
,
, , .
. ,
, .
(Zubin, 1990).
. 2
: («life events») ( : Bebbington, Bowen, Hirsch & Kuipers, 1995) « » («expressed emotion», ) .
, (
Kavanagh, 1992). , ,
. 25 ( 1346 )
9-12 (Bebbington & Kuipers, 1994).
21% , ,
, , (
). ( 50%)
, .
, —
, ,
. ,
, ( , Hornung, Holle, Schulze-Mönking, Klingberg & Buchkremer, 1995; .: De Jesus Mari & Streiner, 1994; Dixon & Lehman, 1995; Wiedemann & Buchkremer, 1996).
. 35.3.2. (Leff, Kuipers, Berkowitz, EberleinBries & Sturgeon, 1982) —
( . . 35.3.2).
35.3.2. ,
, 9- 24-
(Kavanagh, 1992) |
0-9 |
0-24 |
||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Leff et al., 1982, 1985 |
8% |
50% |
50% |
75% |
Falloon et al., 1982, 1985 |
6% |
44% |
17% |
83% |
Kottgen et al., 1984 |
33% |
50% |
— |
— |
Hogarty et al., 1986, 1987 |
19% |
28% |
32% |
66% |
Tarrier et al., 1988, 1989 |
12% |
48% |
33% |
59% |
Leff et al., 1989, 1990 |
8% |
— |
33% |
— |
|
10% |
48% |
33% |
71% |
35.3.2. (LEFF et al.,
1982)
.
-: ,
— 9 ,
.
1) :
, ). :
; ,
.
2) : .
-: 24
; (Catego-System), 8 ,
30 .
-: — CFI (Camberwell Family Interview).
|
|
|
|
|
|
CFI ( ) |
15,8 |
12,0 |
CFI 9 ( ) |
6,8 |
10,7 |
CFI ( ) |
4,0 |
4,0 |
CFI 9 ( ) |
2,4 |
3,7 |
9 |
1 (9%) |
6 (50%) |
,
, .
---
« » ,
. ,
. ( . . 35.3.3), .
,
. ,
.
« » («Social Skills Trainings»);
, , .
35.3.3.
, |
|
|
|
||||
|
|
|
|
|
(Social |
Halford & Hayes (1992) |
|
|
|
|
Skills Training) |
|
|
|
|
|
|
|
|
|
Lehman (1995) |
||
|
|
|
|
|
(Berufl. |
|
|
|
|
|
Rehabilitationsprogramme) |
|
|
|
|
|
(Life |
Glynn & MacKain (1992) |
|
|
Skills Training) |
|
|
|
|
|
Thurm et al. (1991) |
|
|
|
Brenner et al. (1990) |
|
(Kognitive Trainingsprogramme) |
|
|
, |
- |
|
Scharfetter (1982) |
|
(Leiborientierte Therapie) |
|
|
|
- |
|
Vauth & Stieglitz (1994) |
|
(Kognitive Verhaltenstherapie) |
|
|
, ,
,
( . Halford & Hayes, 1992).
,
.
. (Wallace & Liberman, 1985) (
);
28 , .
(«Problem-Lösungs-Strategien»).
« » («holistic health therapy»)
, , , .
. ,
9 , ,
,
.
, , .
(21%) 7 (50%)
.
,
. (Hogarty & Anderson, 1986)
. 88 ,
,
: 1) (n = 28) ,
; 2) (n = 19) ( . 35.3.4); 3)
(n = 21) ( . 35.3.5); 4) (n = 20).
,
, .
,
.
33% , 19%,
— 21%.
.
35.3.4. (Hogarty & Anderson, 1986)
|
|
|
|
|
|
|
|
|
||
1: |
|
|
. |
|
. |
|||||
|
|
|
|
|
|
|
|
|
14 . |
|
|
|
|
|
. |
|
|||||
|
|
|
|
|
, |
|
|
|||
|
|
|
|
|
|
|
|
|
||
|
2: |
|
|
, |
, |
|||||
( ) |
|
: , |
|
, |
, |
|||||
|
|
|
|
, |
|
|
|
|||
