摘要
目标:评估自我管理训练对社区精神分裂症成年患者的效果。方法:总共招募了201例慢性精神分裂症患者(平均病程17.4年),并随机分为自我管理干预组(n=103)和常规治疗对照组(n=98)。自我管理训练包括每周一次小组会议,为期6个月,讨论和模拟基本的自我管理能力,然后进行24个月的每月小组助推会议,社区卫生工作人员回顾患者的自我管理清单。两名对分组单盲的精神科医生评估参与者基线和登记后6个月、30个月的症状和社会功能,采用简明精神病评定量表(BPRS),社会功能缺陷筛选量表(SDSS)和Morningside康复状态量表(MRSS)。总共有194人(干预组99人和对照组95人)完成2.5年的随访。使用末次观察结转法的意向性治疗分析进行分析。结果:相较于对照组,干预组在两个随访时间点的BPRS,SDSS和MRSS平均分较低。在入组后6个月到30个月的治疗维持阶段,干预组的评分持续改善。结论:自我管理训练是一种能改善社区慢性精神分裂症患者的症状和社会功能有效的方法。在6个月的每周自我管理技能训练后,每月的助推会议检查患者记录中与疾病相关的症状事件的日常清单,足以维持培训的有效性。
Aim： Evaluate the effectiveness of self-management training in community-dwelling adults with schizophrenia. Methods：A total of 201 individuals with chronic schizophrenia （mean duraiton of illness of 17.4 years） were recruited and randomized into the self-management interveniton group （n=103） and treatment-as-usual control group （n=98）. The self-management training involved weekly group sessions for 6 months in which basic self-management skills were discussed and modelled followed by monthly group booster sessions for 24 months in which a community health worker reviewed patients’ self-management checklist journals. Two psychiatrists who were blind to group assignment evaluated the symptoms and social functioning of participants at baseline and 6 months and 30 months after enrollment using the Brief Psychiatric Rating Scale （BPRS）, Social Disability Screening Schedule （SDSS）, and Morningside Rehabilitation Status Scale （MRSS）. A total of 194 individuals （99 from the interveniton group and 95 from the control group） completed the 2.5-year follow-up. Intention-to-treat analysis with the last observation carried forward method was used for analysis. Results：Compared to the control group, the interveniton group had lower mean scores in the BPRS, SDSS and MRSS at both follow-up points. The scores in the interveniton group conitnued to improve during the maintenance phase of the treatment from 6 months to 30 months atfer enrollment. Conclusion：Self-management training is an effecitve method to improve symptoms and social funcitoning among individuals with chronic schizophrenia living in the community. Atfer six months of weekly training in self-management skills, monthly booster sessions reviewing patients’ daily checklist of illness-related symptoms events are suffcient to maintain the beneifcial effects of the training. Further study of the long-term cost-effecitveness of this method is needed.
出处
《上海精神医学》
2014年第2期81-87,共7页
Shanghai Archives of Psychiatry
基金
funded by the Shanghai Municipal Health Bureau Young Investigator Grant(20114y028)
关键词
精神分裂症
社区精神卫生服务
自我保健
康复
随机对照试验
盲法评估
schizophrenia
community mental health services
self-care
rehabilitation
randomized controlled trial
blind assessment
