关于社区精神分裂症人群个案管理的两年前瞻性病例对照研究(英文)

背景:以社区为基础的康复方案是精神分裂症患者综合治疗的基本要素。目标:评估以社区为基础的个案管理为精神分裂症患者提供康复服务的长期效果。方法:从上海两区共招募730名符合ICD-10精神分裂症诊断标准的社区居民,380名纳入个案管理组和350名纳入对照组。个案管理涉及每月培训拜访患者和他们的家庭成员,侧重于鼓励患者坚持服药。在24个月中参加者每3个月使用Camberwell需求评价量表(CAN),阳性和阴性症状量表(PANSS),世界卫生组织残疾评定量表(WHO-DAS)和生活质量表(QOLS)进行一次评估。那些没有得到医生批准而停止服用抗精神病药物一个月或更长的患者被归为"自行决定停药"。结果:相比于常规治疗组(即每3个月的随访管理),参加个案管理计划的患者两年随访后停止服药率显著降低,阴性症状的严重程度显著降低,复发率降低并且再住院率也降低了。对停止服药有独立影响的其他因素包括文化程度(受教育程度越高,停药率越高),用药缺乏家庭监督,用药剂量较高,以及与药物相关的不良反应。结论:个案管理是一种可行而且有效的长期方法,可以改善社区精神分裂症患者的康复效果。我们的研究结果强调家人需要参与患者的用药管理,使用药物的最小有效剂量,并积极处理所有的副作用。

Two-year prospective case-controlled study of a case management program for community-dwelling individuals with schizophrenia

Background： A community-based rehabilitation program is an essential element of the comprehensive treatment of individuals with schizophrenia. Objective： Assess the long-term effects of a community-based case management program for providing rehabilitations services to individuals with schizophrenia. Methods： A total of 730 community-residing participants who met ICD-10 diagnostic criteriafor schizophrenia were enrolled, 380 in the case management group and 350 in the control group from two districts in Shanghai. Case management involved monthly training visits with patients and their co-resident family members that focused on encouraging medication adherence. Participants were assessed every three months for 24 months with the Camberwell Assessment of Need （CAN）, Positive and Negative Syndrome Scale （PANSS）, WHO- Disability Assessment Scale （WHO-DAS）, and the Quality of Life Scale （QOLS）. Level of discomfort due to side-effects was also assessed every three months. Individuals who discontinued their antipsychotic medication without physician approval for one month or longer at any time during follow-up were classified as ＇self- determined medication discontinuation＇. Results： Compared to the treatment as usual group （i.e., follow-up management every 3 months）, by the end of the two-year follow-up those who participated in the case management program had significantly lower rates of medication discontinuation, significantly less severe negative symptoms, lower relapse rates and lower rehospitalization rates. Other factors that had an independent effect on discontinuation of medication included educational level （those with more education had higher discontinuation rates）, lack of family supervision of medication, higher dosages of medication, and greater medication-related discomfort. Conclusion： Case management is a feasible and effective outcomes of community residents with schizophrenia long-term method for improving the rehabilitation Our results highlight the need to inv