实施家庭护理干预对精神分裂症患者长期预后的影响

目的探讨家庭护理干预对精神分裂症患者预后的影响。方法将100例出院的精神分裂症患者随机分为干预组和对照组各50例,对照组常规出院宣教,每个月门诊复查或电话咨询,干预组实施家庭干预指导。在出院时及第6个月末和第12个月末两组分别采用NOSIE量表、日常生活能力量表（ADL）、康复状态量表（MRSS）、社会功能缺陷量表（SDSS）评定,并统计1年内复发情况。结果干预组NOSIE总积极因素分明显增高,消极因素分明显降低。与对照组比较差异有统计学意义（P〈0.05或P〈0.01）,干预组ADL、MRSS及SDSS总分在6个月末及12个月末分值逐步下降,显著低于对照组,差异有统计学意义（P〈0.05）。结论实施家庭护理干预可巩固治疗效果,减少疾病复发,促进社会功能康复。     

支持性心理干预联合社区日间康复训练对慢性精神分裂症患者的远期疗效

目的探讨支持性心理干预联合社区日间康复训练对慢性精神分裂症患者的远期康复疗效。方法 2011年10月至2012年9月选取慢性精神分裂症患者,按照随机抽样方法,入选样本84例,随机分为两组:干预组和对照组,每组42例。干预组接受支持性心理干预和社区日间康复干预6个月,对照组按社区常规随访6月。12个月末采用采用阳性与阴性症状量表(PANSS)、康复量表(MRSS)、自知力与态度问卷调查(ITAQ)、复发率和再住院率评估两组的康复疗效。结果干预组、对照组患者入组时PANSS、MRSS以及ITAQ评分差异无统计学意义(P0.05)。干预后干预组的PANSS总分及阴性量表分显著低于对照组,差异有显著性(P0.05)、MRSS总分及依赖性、活动能力、社交能力较对照组下降,ITAQ评分显著高于对照组,差异有显著性(P0.05),症状行为因子分两组无差异(P0.05)。干预组复发率及再住院率显著低于对照组(P0.05),差异具有统计学意义。结论支持性心理干预联合社区日间康复能更好地改善慢性精神分裂症患者的症状、提高其自知力,降低复发率和再住院率,对促进其康复水平有积极意义。     

社区康复训练对慢性精神分裂症患者的效果观察

目的探讨社区康复训练对慢性精神分裂症患者的效果。方法选取我社区慢性精神分裂症患者92例,根据完全随机化原则将其分为对照组和干预组,每组各46例。其中对照组患者给予常规抗精神分裂症药物治疗,干预组在此基础上给予社区康复训练。6个月后观察比较两组患者阳性和阴性症状量表(PANSS)、自知力与治疗态度问卷(ITAQ)、社会功能缺陷筛选量表(SDSS)评分。结果两组患者干预前PANSS、ITAQ与SDSS评分比较,差异均无统计学意义(P0.05)。干预后,干预组PANSS阳性量表、阴性量表、一般精神病理量表评分及总分、ITAQ与SDSS评分改善情况均优于对照组;且与同组干预前比较,以上评分均明显改善,差异均具有统计学意义(P0.05);而对照组以上评分无明显变化,差异无统计学意义(P0.05)。结论社区康复训练可明显改善慢性精神分裂症患者的症状,增强患者自知力和社会功能,促进其康复。     

心理社会综合干预对精神分裂症患者预后的影响

目的探讨心理社会综合干预对精神分裂症患者预后的影响。方法将90例慢性精神分裂症患者随机分为干预组和对照组,干预组和对照组在位院期间均接受常规治疗,出院后要求来院复诊。干预组还接受心理社会综合干预治疗。测评工具为康复状态量表（MRSS）及自制患者情况调查表（GSP）。出院后1年评定。结果出院1年后干预组的MRSS评分低于对照组（P〈0．05）,干预组患者复发例数明显少于对照组,再住院例数和再就业例数明显多于对照组（P〈0．01）。结论心理社会综合干预可以提高慢性精神分裂症患者康复状态,降低复发率。     

综合康复治疗对社区慢性精神分裂症患者认知功能影响的3年随访

目的 探讨社区治疗及家庭心理治疗的综合康复治疗模式对社区慢性精神分裂症患者认知功能的影响.方法 采用随机抽样法,将98例上海市普陀区社区慢性精神分裂症患者随机分为干预组(48例)和对照组(50例),在维持原有抗精神病药物治疗的同时,由专职精神科医师和经过专业培训的社区工作者对干预组组织社区治疗并进行定期综合心理教育式家庭干预,对照组仅为上门随访.于入组前及第3年末分别对两组患者进行阳性症状与阴性症状量表(PANSS) 评定精神症状、Morning Side康复状态量表(MRSS)评定康复状态、韦氏成人智力测验(WAIS-RC)、简易精神状态检查表(MMSE)、威斯康星卡片分类试验(WCST)测定患者认知功能水平.随访3年.结果 观察前后干预组在PANSS总分[(47.43±12.62)与( 42.38±11.40),t=8.89,P=0.001]、MRSS总分[(48.60±2.99)与( 40.46±3.47), t=7.696,P=0.002]、 MMSE[(19.54±2.99) 与( 23.68±1.42), t=3.684,P=0.005]、WCST总测验数[(87.76±20.54) 与( 80.08±21.33 ), t=3.431,P=0.003]等存在统计学差异(P＜0.05).结论 社区治疗及家庭心理治疗的综合康复治疗模式对社区慢性精神分裂症患者的阴性症状,认知功能尤其是执行功能具有明显改善.     

家庭护理干预对精神分裂症患者康复的影响

目的 探讨家庭护理干预对精神分裂症患者康复的影响.方法 将163例精神分裂症患者随机分为2组,均于干预前和8周末采用简明精神病症状量表(BPRS)、自知力与治疗态度问卷(ITAQ)、社会功能筛选量表(SDSS)进行评价比较.结果 2组入组时各量表评分比较差异无统计学意义(P＞0.05).干预8周末研究组BPRS总分及焦虑抑郁和缺乏活力因子分均明显低于对照组,差异有统计学意义(P＜0.05);ITAQ评分研究组为(17.24±0.48),对照组为(9.56±0.42),2组差异有统计学意义(P＜0.01);SDSS总分及各因子分均明显高于对照组,2组差异有统计学意义(P＜0.01).结论 家庭护理可有效促进精神分裂症患者康复.     

精神分裂症社区康复疗效的对照研究

目的 探讨精神分裂症患者社区康复的办法及可行性.方法 将60例精神分裂症患者随机分为干预组和对照组,每组30例.干预组开办家庭病床,每周进行一次家访,对患者进行检查并对其及家属进行心理治疗、康复训练、用药指导.对照组只进行家访,不做任何指导.持续随访一年.用阳性和阴性症状量表(PANSS),社会功能缺陷筛选量表(SDSS),康复状态量表(MRSS)和复发率,再住院率,再就业率进行评估.结果 1、干预组患者PANSS总分及各分量表分自第2月起减分率明显优于对照组(P<0.01);2、干预组MRSS、SDSS均显著优于对照组;3、干预组复发率(10.0%),再住院率(3.3%),再就业率(43.3%),显著低于对照组复发率(63.3%),再住院率(43.3%),再就业率(10.0%),(X2=40.6,13.7,6.7,P<0.01).结论 慢性精神分裂症患者通过社区干预,可有效改善精神分裂症患者的症状,提高其社会适应能力,是行之有效的.     

护理干预对康复期精神分裂症病人社会功能恢复的对照研究

目的为探讨护理干预对康复期精神分裂症病人社会功能恢复的影响。方法将108例康复期精神分裂症病人随机分为干预组和对照组,干预组在常规治疗护理的基础上进行以社会技能训练为主的护理干预,于干预前及干预8周末,采用康复状态量表(MRSS)、社会功能缺陷筛选量表(SDSS)进行效果评定。结果干预组MRSS、SDSS评分较干预前均显著性差异(P＜0．01)。结论护理干预明显提高了康复期精神分裂症病人的社会功能的恢复。     

系统康复治疗对慢性精神分裂症患者的随访研究

目的探讨系统康复治疗对慢性精神分裂症患者的康复效果。方法将80例慢性精神分裂症患者按入院顺序分为康复组和对照组,每组40例。在常规住院治疗的基础上单独对康复组病人施以为期3个月的系统康复治疗,用BPRS、自知力与治疗态度问卷（ITAQ）和社会功能缺陷筛选量表（SDSS）于入组时、出院时和出院后1a对患者进行相关评定。结果出院时2组BPRS、SDSS、ITAQ总分均较入组时有明显改善,康复组较为明显（P〈0.05或P〈0.01）;并维持至出院1a仍显著优于对照组（P〈0.05）;且1a内的复发率和再住院率显著低于对照组（P〈0.05）。结论系统康复治疗可提高慢性精神分裂症患者的治疗依从性,改善患者的精神症状,降低复发率和再住院率,有益于患者社会功能恢复。     

精神分裂患者长期住院与社区康复治疗对照研究

目的探讨精神分裂症长期住院与社区康复治疗两组患者疗效、社会功能缺陷以及对社会的影响、卫生经济学指标有何差异。方法以住院治疗慢性精神分裂症患者300例及在社区康复站治疗300例进行为期一年的观察，采用BPRS、PANSS、SDSS量表，自编肇事肇祸危险性评估量表及生活质量和总体幸福感量表分别对两组患者进行评分。结果两组BPRS、PANSS减分率、总有效率差异无显著性意义。治疗组SDSS在治疗第3、6月下降，与治疗前有显著性（P〈0．05）；第9、12月又上升，与治疗前差异无显著性意义；对照组则一直下降，与治疗前比较差异有非常显著性意义（P〈0．01）。治疗组肇事肇祸危险性评估分值少于对照组（P〈0．05）。对照组家属生活满意度及总体幸福感明显好于治疗组（P〈0．01）。对照组平均每月医疗费用明显低于治疗组（P〈0．01）。结论开展社区康复治疗对慢性精神分裂患者可以达到理想的疗效；较好的社会功能，较低的肇事肇祸率，减轻家庭及政府的经济负担，提高家属及患者的生活质量。     

北京城市卒中社区康复及危险因素自我管理效果分析

目的应用以引导式教育为内容的康复治疗和危险因素自我管理措施,评价其对促进卒中患者卒中知识知晓、行为改善及功能恢复的作用。方法在北京市东城区选择两个社区分别作为干预社区与对照社区,结合现代康复理念、引导式教育、危险因素自我管理,先后对干预社区109例患者开展3个月的卒中康复治疗及6个月危险因素自我管理干预。通过卒中患者自身治疗和干预前、后比较以及与对照社区110例患者比较,评价干预效果。结果经3个月康复治疗后,干预社区卒中患者简化的Fugl-Meyer运动功能量表评分从57.0(30.0,81.5)分提高到70.5(40.5,92.0)分(P0.001);Barthel指数评分从90(65,95)分提高到95(75,100)分(P0.001);社会功能活动问卷评分从(11.6±8.3)分降低到(10.1±8.4)分(P=0.001)。经过6个月自我管理,干预社区卒中患者对危险因素(P0.001)、预警知识(P0.001)和康复技能知晓(P0.001)以及血糖控制(P=0.033)和坚持康复治疗情况(P0.001)均显著高于对照社区卒中患者。结论社区卒中康复及危险因素自我管理干预,可以提高卒中相关知识知晓、改善行为习惯和功能恢复。     

社区干预对精神分裂症患者的作用

目的：探索主动性社区干预的康复治疗方法对社区精神分裂症患者的作用。方法：精神分裂症128例,连续1年的主动性访视干预社区治疗康复效果。结果：在维持药物治疗的基础上,主动性访视干预1年后精神分裂症患者的简明精神病评定量表（BPRS）各因子、临床疗效总评量表（CGI）评分下降有显著性,世界卫生组织生活质量简表（WHOQOL-BREF）各因子自我评分和总体生活质量评分均高于1年前。结论：主动性访视干预康复对精神分裂症患者有效。     

Systematic intervention for supporting community care of elderly people after a delirium episode

OBJECTIVE: To investigate the effects of a systematic intervention with a case manager concept and rehabilitation periods compared to standard aftercare in elderly community-dwelling patients discharged from the hospital after a delirium episode. DESIGN: Before/after intervention cohort study with 3-year follow-up. SETTINGS: Acute geriatric wards of a city hospital and a private rehabilitation center. SUBJECTS AND METHODS: The intervention group consisted of 51 community-dwelling people over 65 years of age without severe underlying disorders, who were consequently admitted as emergency cases to the hospital because of a delirious state or who were delirious immediately after admission. The intervention included continuous support and counseling by a nurse specialist and rehabilitation periods at a rehabilitation center. The control group consisted of 51 age- and gender-matched patients admitted to the same hospital for delirium fulfilling the same inclusion and exclusion criteria during preceding years. The main outcome measures were duration of community care, the use of long-term institutional care, the use of short-term hospitalizations during the follow-up, and the death of the patients. RESULTS: Delirium even in the healthy community-dwelling subjects indicated a poor prognosis. After 3 years, 18 patients (35%) from the intervention group and 9 patients (18%) from the controls were in community care. The mean duration of community care was 671 days in the intervention group and 503 days in the control group, p = .025. A reduction of 19 years was achieved in the cumulative time spent in long-term institutionalized care. The use of short-duration hospitalization was similar in both groups. CONCLUSION: The institutionalization of elderly patients after a delirious state could be delayed using rehabilitation periods and systematic intervention with the case manager concept.     

社区家庭干预对精神分裂症患者及家属的作用

本文系前瞻性对照研究，对上海市区两个街道的120例精神分裂症患者进行家庭干预的对照研究。结果提示，实施家庭干预结合家庭教育，对社区的精神病患者确能起到缓解病情，减少复发，提高社会功能及促进康复的作用。     

There's no place like home : an evaluation of early supported discharge for stroke

BACKGROUND AND PURPOSE: Because stroke management is aimed at facilitating community reintegration, it would be logical that the sooner the patient can be discharged home, the sooner reintegration can commence. The purpose of this study was to determine the effectiveness of prompt discharge combined with home rehabilitation on function, community reintegration, and health-related quality of life during the first 3 months after stroke. METHODS: A randomized trial was carried out involving patients who required rehabilitation services and who had a caregiver at home. When medically ready for discharge, persons with stroke were randomized to either the home intervention group (n=58) or the usual care group (n=56). The home group received a 4-week, tailor-made home program of rehabilitation and nursing services; persons randomized to the usual care group received services provided through a variety of mechanisms, depending on institutional, care provider, and personal preference. The main outcome measure was the Physical Health component of the Measuring Outcomes Study Short-Form-36 (SF-36). Associated outcomes measures included the Timed Up & Go (TUG), Barthel Index (BI), the Older Americans Resource Scale for instrumental activities of daily living (OARS-IADL), Reintegration to Normal Living (RNL), and the SF-36 Mental Health component. RESULTS: The total length of stay for the home group was, on average, 10 days, 6 days shorter than that for the usual care group. There were no differences between the 2 groups on the BI or on the TUG at either 1 or 3 months after stroke; however, there was a significantly beneficial impact of the home intervention on IADL and reintegration (RNL). By 3 months after stroke, the home intervention group showed a significantly higher score on the SF-36 Physical Health component than the usual care group. The total number of services received by the home group was actually lower than that received by the usual care group. CONCLUSIONS: Prompt discharge combined with home rehabilitation appeared to translate motor and functional gains that occur through natural recovery and rehabilitation into a greater degree of higher-level function and satisfaction with community reintegration, and these in turn were translated into a better physical health.     

Long-term effectiveness of combined cognitive-behavioral and neuropsychological intervention in a case of multiple sclerosis

This study examines the long-term effectiveness of a combined cognitive-behavioral and neuropsychological intervention in a woman of 19 years old with multiple sclerosis, by evaluating functional neuroimaging, neuropsychological and psychometric testing. The results showed a partial improvement in some brain areas and brain inflammatory activity. There was an increase in attention, verbal memory, and nonverbal executive functioning as well as in the emotional state at posttest and one-year follow-up. This study indicates the need for including components of both cognitive-behavioral therapy and neuropsychological rehabilitation based on an individualized and tailored plan in standard treatments for multiple sclerosis. Future studies should further develop these contributions.     

社区个体化干预对精神分裂症的康复作用

目的探索社区个体化干预对精神分裂症康复效果的有效途径。方法采用随机抽样法，对50例精神分裂症患者进行为期二年的社区个体化干预，并设50例对照组。社会功能缺陷筛选量表、Morning Side康复状态量表评估患者的康复情况。结果干预组患者复发8例，复发比例16％；对照组复发20例，复发比例40％，两组差异有统计学意义（，=53．65，P〈0．01）。干预组患者的社会功能缺陷筛选量表总分和Morning Side康复状态量表各项分数也优于对照组。结论社区个体化干预对精神分裂症患者的康复是有效方法之一。     

Cognitive strategies versus self-management skills as adjunct to vocational rehabilitation

Cognitive dysfunctions and negative symptoms are "rate-limiting factors" for community outcome and response to psychosocial intervention in people with schizophrenia. Therefore, two cognitive-behavioral group therapies were developed-computer-assisted cognitive strategy training (CAST) and training of self-management skills for negative symptoms (TSSN)-to target these barriers to rehabilitation readiness. One hundred thirty-eight DSM-IV schizophrenia inpatients on a rehabilitation ward were randomly assigned to CAST plus vocational rehabilitation, TSSN plus vocational rehabilitation, or vocational rehabilitation alone. CAST included computer-based training in coping strategies focusing on deficits in attention, verbal memory, and planning. TSSN focused on social withdrawal/social anhedonia, lack of drive/volition, and affect flattening using techniques such as time scheduling, mastery, and pleasure techniques. Treatment outcome was assessed at intake and at discharge after 8 weeks. Analyses of covariance controlling for basis-level functioning demonstrated that patients receiving CAST plus vocational rehabilitation showed greater improvement on attention and verbal memory but not on planning ability. Patients receiving TSSN plus vocational rehabilitation failed to demonstrate improvement in negative symptoms. CAST plus vocational rehabilitation was found to be associated with a higher rate of successful job placement at the 12-month followup interval. Hierarchical logistic regression analyses demonstrated that improvement in short- and long-term verbal memory predicted a higher proportion of variance of successful job placement in the followup than pretreatment history of employment alone. Cognitive training as an adjunct to inpatient vocational rehabilitation demonstrated cognitive improvement, which was found to be associated with successful job placement in the followup. TSSN's efficacy was less clear; reasons for this uncertainty are provided.     

Assessing the Implementation and Effects of a Trauma-Focused Intervention for Youths in Residential Treatment

This paper describes methods being used to implement and assess the effects of a trauma-focused intervention in residential treatment programs for youths with emotional and behavioral problems, and histories of maltreatment and exposure to family or community violence. Preliminary baseline profiles of the therapeutic environments and youths are also presented. The intervention, referred to as the Sanctuary Model® (Bloom, 1997), is based in social psychiatry, trauma theories, therapeutic community philosophy, and cognitive-behavioral approaches. Within the context of safe, supportive, stable, and socially responsible therapeutic communities, a trauma recovery treatment framework is used to teach youths effective adaptation and coping skills to replace nonadaptive cognitive, social, and behavioral strategies that may have emerged earlier as means of coping with traumatic life experiences.     

Effects of a CHANGE intervention to increase exercise maintenance following cardiac events

Background: Despite participation in a cardiac rehabilitation program, there is a downward trajectory of exercise participation during the year following a cardiac event.Purpose: The purpose of this study was to test the effectiveness of CHANGE (Change Habits by Applying New Goals and Experiences), a lifestyle modification program designedto increase exercise maintenance in the year following a cardiac rehabilitation program. The CHANGE intervention consists of 5 small-group cognitive-behavioral change counseling sessions in which participants are taught self-efficacy enhancement, problem-solving skills, and relapse prevention strategies to address exercise maintenance problems.Method: Participants (N = 250) were randomly assigned to the CHANGE intervention (supplemental to usual care) or a usual-care-only group. Exercise was measured using portable wristwatch heart rate monitors worn during exercise for 1 year. Cox proportional hazards regression was used to determine differences in exercise over the study year between the study groups.Results: Participants in the usual-care group were 76% more likely than those in the CHANGE group to stop exercising during the year following a cardiac rehabilitation program (hazard ratio = 1.76, 95% confidence interval = 1.08–2.86, p = .02) when adjusting for the significant covariates race, gender, comorbidity, muscle and joint pain, and baseline motivation. Most participants, however, had less than recommended levels of exercise amount and intensity.Conclusions: Counseling interventions that use contemporary behavior change strategies, such as theCHANGEintervention, can reduce the number of individuals who do not exercise following cardiac events. This study was funded by a grant from the National Institute of Nursing Research at the National Institutes of Health R01-NR04704. We acknowledge the contributions of the cardiac rehabilitation staff at Parma Community Hospital, University Hospitals of Cleveland, and the Cleveland Clinic Foundation.