社区医生督导对重性精神障碍患者服药依从性和疗效的影响

目的探讨社区医生督导对重性精神障碍患者的服药依从性及治疗效果的影响。方法选取于2013年2月2日至2015年2月1日期间居住于同一社区的重性精神障碍患者175例,对所有患者进行六级危险性评估,依据临床表现对所有患者作四级管理分类,并根据管理分类,为每位患者制定个性化社区医生督导方案。2年后,收集所有患者服药依从率、症状好转率、社区集体康复活动参与率、肇事肇祸率等资料,并与2年前进行对比。结果与管理前相比,患者服药依从率从59.1%上升到70.2%;社区集体康复活动参与率从27.3%上升到70.1%;肇事肇祸率从44.4%下降到11.4%,差异具有统计学意义(P0.01)。结论应用社区医生督导能有效提高重性精神障碍患者的服药依从性和疗效,对提高患者医疗效果有着积极作用。     

湖南省严重精神障碍患者肇事肇祸行为的影响因素分析

目的 探讨严重精神障碍患者肇事肇祸的主要影响因素。方法 在湖南省严重精神障碍信息管理系统中筛选出2019年11月～2020年10月期间有肇事肇祸行为的患者489例作为研究组,随机抽取无肇事肇祸行为的患者489例作为对照组,共978例患者作为研究对象。采用χ2检验及二元逐步Logistic回归分析肇事肇祸行为的影响因素。结果 男性、中青年(18～44岁、45～60岁)、文化程度低、户别为城镇、自知力缺乏、服药不规律、不参加社区康复服务是患者发生肇事肇祸行为的危险因素,差异均有统计学意义(P0.05)。结论 应重点关注自知力缺乏、服药不规律、男性、18～60岁、文化程度低、户别为城镇、不参加社区康复服务的严重精神障碍患者,采取针对性措施,降低肇事肇祸行为发生率。     

对易肇事肇祸严重精神障碍患者实施村医全程督导服药管理的效果

目的 探讨易肇事肇祸严重精神障碍患者在村医全程督导服药管理下的效果.方法 在石家庄市随机选取2个县(区)作为试点,对登记在册的严重精神障碍患者进行筛查,采用社会功能缺陷量表(SDSS)、患者危险性评估表(参照《重性精神疾病管理治疗工作规范(2012年版)》危险性评估)分别在入组时以及干预后3,6,9,12个月时,对患者的社会功能和危险性进行评定,并比较两组患者的再入院率.结果 干预9个月后干预组的SDSS评分明显优于对照组,干预6个月后干预组的危险性等级明显低于对照组,两组差异均有统计学意义(P<0.01);干预其间,干预组中12例次(12.12%)再次住院接受治疗,对照组有65例次(66.33%),两组差异有统计学意义(χ2=60.777,P<0.01).结论 对易肇事肇祸严重精神障碍患者进行全程督导服药管理能够改善患者的社会功能,降低患者的危险性分级,减少对家庭社会的影响,降低患者的再住院率.     

严重精神障碍患者连续化“专全结合”管理模式效果评价北大核心CSCD

目的评估天津市严重精神障碍患者连续化“专全结合”管理模式的实施效果。方法回顾性收集2018-2020年由天津市精神卫生中心明确诊断并接受社区随访管理的6种严重精神障碍患者,包括精神分裂症、偏执性精神病、分裂情感性障碍、双相(情感)障碍、癫痫所致精神障碍、精神发育迟滞伴发精神障碍,将患者分为由天津市精神卫生中心负责指导的连续化“专全结合”管理模式组(试点组),共计1435例,以及由其他精神卫生医疗机构负责指导的非连续化“专全结合”管理模式组(非试点组),共计3514例。以规范管理、规律服药、病情稳定、发生危险行为情况来评估患者管理效果。结果单因素分析显示,试点组规范管理(99.02%vs.97.89%)、病情稳定(91.85%vs.85.83%)患者比例高于非试点组(P<0.01),规律服药(89.97%vs.90.10%)、发生危险行为(0.35%vs.0.46%)情况组间无统计学差异(P>0.05)。控制一般资料,多因素logistic回归分析显示,试点组患者规范管理率高于非试点组患者(OR=2.08,95%CI:1.11~3.92),规律服药率高于非试点组(OR=1.56,95%CI:1.23~1.99)。结论连续化“专全结合”管理模式能提高社区严重精神障碍患者的规范管理率及服药依从性。     

南宁市兴宁区肇事肇祸重性精神疾病患者情况调查

目的:了解南宁市兴宁区重性精神疾病患者肇事肇祸情况及危险因素。方法:对登记在册的兴宁区712例重性精神疾病患者进行危险性评估,了解其有无肇事肇祸情况。结果:712例重性精神疾病患者中有肇事肇祸患者148例,占20.79%,其中精神分裂症患者中最多,占20.96%;肇事肇祸的发生与患者的性别、婚姻、家族史、服药依从性等原因有关。结论:需要针对高危的社区重性精神疾病患者加强监管和治疗。     

2015年陕西省严重精神障碍患者管理治疗现状调查

目的 分析2015 年陕西省严重精神障碍患者管理治疗情况,为政府相关部门制定精神卫 生政策及精神卫生专业机构开展服务提供参考。方法 采用描述性分析方法对2011年8月1日—2015年 12 月31 日陕西省录入国家严重精神障碍信息系统中患者的一般状况和登记、管理、治疗情况等进行分 析。结果 截至2015 年底,陕西省累计登记在册严重精神障碍患者126 120 例,报告患病率3.35‰;在 管患者115 993 例,管理率91.97%,规范管理患者70 378 例,规范管理率55.8%;服药患者61 270 例,服 药率52.82%,规律服药患者30 781 例,规律服药率26.54%。结论 陕西省严重精神障碍管理治疗工作 已在全省开展并取得一定成效,但报告患病率、规范管理率和规律服药率需进一步提高。     

个案管理服务对社区重性精神疾病的效果

目的探讨个案管理服务对社区重性精神疾病的效果,为推进个案管理工作提供参考。方法选取2015年1月-2016年1月佛山市某社区参加个案管理服务的50例重性精神疾病患者为研究对象,采用量表(BPRS)、服药态度量表(DAI)和自制个案管理实施效果评估访谈表,评估个案管理服务的效果。结果参加个案管理后,患者及家人总满意度为85.26%,肇事肇祸为0,复发住院率下降了66.67%,就业率由参加前的8%提高到18%。结论个案管理服务可能有利于稳定社区重性精神疾病患者的病情,减少肇事肇祸发生率和复发住院率,提高就业率,提高家属的满意度及社会效益。     

严重精神障碍社区管理治疗典型案例分析

采用描述性统计方法,对四川省2016年-2017年在册严重精神障碍患者所致严重肇事肇祸的4个典型案例进行分析,研究其危险行为发生的相关危险因素,为严重精神障碍患者社区管理治疗提供参考。结果表明,严重精神障碍患者危险行为发生的相关危险因素主要有:患者信息流转不畅、部门间信息交换未开展、患者监护人责任意识差等。     

深圳市社区严重精神障碍不服药患者发生暴力行为的影响因素分析

目的分析深圳市社区严重精神障碍不服药患者暴力行为发生的相关因素。方法利用深圳市精神卫生防治工作信息管理系统收集严重精神障碍患者个案资料和随访资料,描述分析不服药患者暴力行为的发生现状,应用Logistic回归模型分析其影响因素。结果3163例社区严重精神障碍不服药患者中9.1%(288/3163)的患者发生暴力行为。多元Logisitic回归分析显示,急性起病(OR=1.589,95%CI 1.181~2.139)为暴力行为发生的危险因素;有共同居住者(OR=0.596,95%CI 0.410~0.867)、精神发育迟滞伴发精神障碍(OR=0.432,95%CI 0.199~0.938)、申请监护补助(OR=0.440,95%CI 0.319~0.606)、签约家庭医师服务(OR=0.642,95%CI 0.492~0.838)和社区面访(OR1-2次=0.633,95%CI 0.466~0.861;OR3-4次=0.546,95%CI 0.368~0.811)为暴力行为发生的保护因素。结论急性起病的严重精神障碍不服药患者暴力行为发生率较高。提升社区精神卫生综合服务水平,制定有针对性的干预措施,有助于降低社区严重精神障碍不服药患者暴力行为的发生。     

山东日照地区重性精神疾病患者管理治疗和肇事肇祸情况调查分析

目的:对山东日照地区重性精神疾病患者管理治疗状况和肇事肇祸情况进行调查分析。方法:对日照市城乡部分登记在册的重性精神疾病患者进行疾病分类管理并对肇事肇祸情况进行危险性评估。结果:重性精神疾病患者中未治疗的患者占26.34%、门诊治疗的患者占34.31%,住院治疗的患者占39.35%。患者中肇事肇祸发生率为82.37%,其中精神分裂症患者肇事肇祸最多。危险性评估为高风险患者占53.30%。结论:重性精神疾病患者治疗不足,肇事肇祸发生多,应该加强这一特殊人群的管理和治疗。     

Increased risk of mental disorders among lifetime victims of stalking--findings from a community study.

PURPOSE: Population-based studies on the relationship between stalking and mental health outcomes in victims are scarce. The aim of the present study was to assess associations between stalking victimization and specific DSM-IV mental disorders in a community sample. METHOD: A postal survey was conducted in a middle-sized German city (sample size=675). Lifetime stalking victims and non-victims were compared regarding rates of any mental disorder, comorbid mental disorders, and specific disorders assessed by the Patient Health Questionnaire (PHQ). RESULTS: Victims had a higher incidence of mental disorders and comorbid mental disorders. Sex- and age-adjusted rates of specific disorders were increased, with the most robust associations identified for major depression (OR 4.8, 95% CI 1.8-12.8) and panic disorder (OR 4.1, 95% CI 1.1-14.9). Victims also reported higher current use of psychotropic medication (20.8% versus 5.6%). CONCLUSIONS: Our study indicates substantial associations between stalking victimization and impaired mental health that can be quantified at diagnostic levels in the general population. To confirm these findings, larger community studies are needed, which also include an assessment of lifetime psychopathology and of factors potentially mediating the associations between stalking victimization and mental health.     

甘肃省70538例居家重性精神疾病患者管理效果评价

目的掌握甘肃省重性精神疾病患者居家管理的干预现状,并对管理效果做出评价,为今后对重性精神疾病患者更好地进行社区康复管理、救治救助奠定基础。方法依据重性精神疾病管理治疗工作规范(2012年版)和国家基本公共卫生服务规范(2011年版),对甘肃省2015年1月至2016年4月期间,通过普查和线索调查筛查出疑似患者并确诊,然后进行随访,进一步收集和分析其接受随访管理(在管)、治疗、服药、危险行为发生情况等信息。结果甘肃省共计确诊重性精神疾病患者70538例,其中在管患者占81.08%(57195例)。在管、非在管和失访的重性精神疾病患者中,治疗率为69.92%(48009/68663),其中双相情感障碍的治疗率(76.00%)最高(均P0.001)。在管居家患者的服药率为42.16%(24113/57195),规律服药率为24.74%(14150/57195),其中偏执性精神病的服药率(51.98%)最高(均P0.001),癫痫所致精神障碍的规律服药率(31.02%)最高(均P0.001)。结论目前甘肃省重性精神疾病居家管理率、治疗率、在管居家患者的服药率和规律服药率均低于全国平均水平,在普及精神疾病防治知识和提高医务人员对重性精神疾病规范化治疗能力等方面需大力加强。     

佛山市顺德区重性精神疾病患者肇事肇祸情况调查

目的了解佛山市顺德区重性精神疾病患者的肇事肇祸等情况。方法对登记在册的4107例重性精神疾病患者进行一般信息统计和基础情况调查,评估其危险性,了解其肇事肇祸情况。结果4107例重性精神疾病患者中,肇事肇祸患者共962例（23％）,肇事肇祸患者以精神分裂症（62％）最多见,并且具有男性（63．7％）为多、未婚和丧偶较多、经济状况较差、服药依从性差和阳性家族史较多的特点。结论要重视重性精神疾病患者的药物治疗,并建立有效的社区干预模式。     

Mental disorders and asthma in the community

OBJECTIVE: To determine the association between asthma and mental disorders among adults in the community. SETTING: Germany. PARTICIPANTS: Representative sample of the general population aged 18 to 65 years. MAIN OUTCOME MEASURES: Diagnoses of current (the past 4 weeks) and lifetime asthma were based on physician diagnosis; current and lifetime DSM-IV mental disorders were assessed using the Composite International Diagnostic Interview. RESULTS: Current severe asthma (the past 4 weeks) was associated with a significantly increased likelihood of any anxiety disorder (odds ratio [OR], 2.65; 95% confidence interval [CI], 1.35-5.18), specific phobia (OR, 4.78; 95% CI, 2.35-4.05), panic disorder (OR, 4.61; 95% CI, 1.09-9.4), and panic attacks (OR, 4.12; 95% CI, 1.32-12.8). Lifetime severe asthma was associated with the increased likelihood of any anxiety disorder (OR, 2.09; 1.3-3.36), panic disorder (OR, 2.61; 95% CI, 1.29-5.25), panic attacks (OR, 2.84; 95% CI, 1.66, 4.89), social phobia (OR, 3.28; 95% CI, 1.42, 7.59), specific phobia (OR, 2.93; 95% CI, 1.71-5.0), generalized anxiety disorder (OR, 5.51; 95% CI, 2.29-13.22), and bipolar disorder (OR, 5.64; 95% CI, 1.95-16.35). Current nonsevere asthma was associated with the increased likelihood of any affective disorder (OR, 2.42; 95% CI, 1.03-5.72); and lifetime nonsevere asthma was associated with increased odds of any anxiety disorder (OR, 1.51; 95% CI, 1.0-2.32), anxiety disorder not otherwise specified (OR, 2.08; 95% CI, 1.03-4.23), and any somatoform disorder (OR, 1.7; 95% CI, 1.14-2.53). CONCLUSIONS: To our knowledge, these findings are consistent with and extend the findings of previous reports by providing the first available information on the association between physician-diagnosed asthma and DSM-IV mental disorders in a representative population sample of adults. Our results suggest an association between asthma and a range of mental disorders. Longitudinal studies that can examine the sequence of onset and the role of genetic and environmental factors in the association between asthma and affective and anxiety disorders are needed next to further elucidate possible shared causative mechanisms.     

The effectiveness of assertive community treatment for homeless populations with severe mental illness: a meta-analysis

OBJECTIVE: The purpose of this study was to assess the effectiveness of assertive community treatment in the rehabilitation of homeless persons with severe mental illness using a meta-analysis. METHOD: A structured literature search identified studies for review. Inclusion criteria were the use of an assertive community treatment-based rehabilitation treatment in an experimental or quasi-experimental model, exclusive treatment of homeless subjects, and follow-up of housing and psychiatric outcomes. Two reviewers independently abstracted data on methodology and outcomes from included studies. The authors calculated effect differences, summary effects and confidence intervals (CIs) for housing, and hospitalization and symptom severity outcomes. RESULTS: Of the 52 abstracts identified, 10 (19%) met inclusion criteria. Of these, six were randomized controlled trials, and four were observational studies, totaling 5,775 subjects. In randomized trials, assertive community treatment subjects demonstrated a 37% (95% CI=18%-55%) greater reduction in homelessness and a 26% (95% CI=7%-44%) greater improvement in psychiatric symptom severity compared with standard case management treatments. Hospitalization outcomes were not significantly different between the two groups. In observational studies, assertive community treatment subjects experienced a 104% (95% CI=67%-141%) further reduction in homelessness and a 62% (95% CI=0%-124%) further reduction in symptom severity compared with pretreatment comparison subjects. CONCLUSIONS: Assertive community treatment offers significant advantages over standard case management models in reducing homelessness and symptom severity in homeless persons with severe mental illness.     

The effect of a managed behavioral health carve-out on quality of care for medicaid patients diagnosed as having schizophrenia

CONTEXT: Managed behavioral health carve-outs (MBHCOs) are a regular feature of public and private mental health care systems and have been successful in reducing costs. The evidence on quality impacts is limited and suggests comparable quality overall, except that people with severe psychiatric disorders may be those most disadvantaged by MBHCOs. OBJECTIVE: To explore the effect of implementing an MBHCO on the quality of outpatient care received by enrollees diagnosed as having schizophrenia. DESIGN AND PARTICIPANTS: Observational retrospective cohort study using a quasi-experimental design of state Medicaid enrollees diagnosed as having schizophrenia, aged 18 to 64 years between 1994 and 2000 in the carve-out and comparison regions (8082 person-years). SETTING: Ambulatory care. MAIN OUTCOME MEASURES: Quality indicators derived from the Schizophrenia Patient Outcomes Research Team recommendations. RESULTS: There was no statistical difference between the carve-out and integrated arrangements in the likelihood of receiving any antipsychotic medication (odds ratio [OR], 1.02; 95% confidence interval [CI], 0.81-1.29), second-generation antipsychotics (including clozapine: OR, 1.05; 95% CI, 0.86-1.28; not including clozapine: OR, 1.05; 95% CI, 0.85-1.29), or antiextrapyramidal medication (OR, 1.36; 95% CI, 0.84-2.19). The carve-out was negatively associated with receiving any individual therapy (OR, 0.27; 95% CI, 0.22-0.33), group therapy (OR, 0.19; 95% CI, 0.14-0.25), and psychosocial rehabilitation (OR, 0.31; 95% CI, 0.26-0.38). Family therapy occurred for less than 1% of this population in both carve-out and integrated regions. CONCLUSIONS: The MBHCO was not associated with changes in medication quality (for which it was not at financial risk). It was significantly associated with sharp decreases in the likelihood of receiving psychosocial treatments (for which it was financially at risk)-independent of whether a clinical evidence base supported them.     

Psychiatric disorders and left-handedness in children living in an urban environment

The objective of this study was to conduct an analysis of left-handed children treated in an urban mental health clinic to investigate the frequency and severity of psychiatric disorders compared to right-handed peers. Data on handedness, diagnoses, hospitalizations and severity of mental disorders were collected on 692 consecutive children, 4–18 years old (M = 10.1, SD = 3.2), referred for psychiatric evaluation. Left-handed children were 18.2% of patients in the study, a rate significantly higher than left-hand dominance in the USA (p < .05). Compared to children with right-handedness, logistic regression analysis yielded 31% [odds ratio (OR) = 1.31, 95% confidence interval (CI): 1.15–1.50] higher odds of having more psychiatric diagnosis, 70% (OR = 1.70, 95% CI: 1.10–2.62) increased odds of anxiety, 53% (OR = 1.53, 95% CI: 1.03–2.27) increased odds of depression and 78% (OR = 1.78, 95% CI: 1.21–2.62) increased odds of oppositional defiant disorder for children who were left-handed. Left-handed children had increased odds of being prescribed antipsychotic and anxiolytic medication uses, 53% and 86% increased odds, respectively, and 66% (OR = 1.66, 95% CI: 1.08–2.55) increased odds of psychiatric hospitalizations. Left-handedness was a phenotypic risk factor for psychiatric disorders and increased severity of psychiatric disorders.     

An epidemiological survey of mental disorders 5 years after the Lushan earthquake in Ya’an,China

Purpose

This study aimed to (1) explore the prevalence and relevant influencing factors of different mental disorders 5 years after the Lushan earthquake in Ya’an, China.

Methods

An epidemiological mental health survey was conducted to identify the prevalence of mental disorders in general population in Ya’an. A multi-stage, group-matching random sampling method was adopted. Face-to-face interviews were done with a two-stage design by trained interviewers and psychiatrists. The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) was used for the diagnosis.

Results

There were 8876 participants who were interviewed in this study. The total 12-month and lifetime prevalence of all mental disorders were 12.5% and 14.7%, respectively. There was a significant difference between males and females in the prevalence patterns of several mental disorders. Han ethnic group had higher prevalence of anxiety disorders (2.7%), and the Tibetan group had higher prevalence of alcohol-related disorders (5.0%). Logistic regression analysis showed that the areas severely affected by the earthquake had significantly higher prevalence of depressive disorders, and the extremely severe affected areas had significantly higher prevalence of trauma- and stressor-related disorders.

Conclusion

Our findings show that the prevalence of a range of mental disorders 5 years after the earthquake in Ya’an are high, and the prevalence of depressive and trauma- and stressor-related disorders may be influenced differently by the various severity of earthquake impact. This study may be crucial for the health policy-making, cultural-specific mental health services and long-term mental recovery after the earthquake.