社区个体化全病程管理对精神分裂症患者生活质量的影响

目的探讨社区个体化全病程管理对精神分裂症患者生活质量、家庭负担的影响。方法将符合入组标准的精神分裂症患者82例随机分为研究组41例和对照组41例，研究组用社区个体化全病程管理方法，对照组则进行传统的门诊随访治疗。用阳性和阴性症状量表（PANSS）评定精神症状严重程度，每半年量表评定一次；用生活质量综合评定问卷-74（成人用）（GQOLI-74）、家庭负担会谈量表（Family Burden Schedule，FBS）评定生活质量和家庭负担，在治疗开始、治疗2年末测定。结果治疗2年末：研究组GQOLI得分及其社会功能维度与对照组比较差异有统计学意义（t=2.015，P=0.048，t=2.387，P=0.020）。在睡眠与精力、躯体不适感、业余娱乐生活、生活质量的总体评价四个因子方面，研究组与对照组比较差异有统计学意义（P〈0.05）；研究组FBS总分、因子分家庭日常活动、家庭关系与对照组比较差异有统计学意义（t=3.157，P=0.002；t=2.538，P=0.013；t=3.002，P=0.004）。结论在经济发达的中心城区，对精神分裂症患者实施社区个体化全病程康复治疗方案，在高度个体化治疗的前提下，充分利用社区资源和中心城区环境优势，将各种治疗有效地系统整合，借鉴国外的病案管理的模式,对患者进行全程跟踪随访，有利于提高患者的生活质量，减轻家庭对疾病的负担，改善疾病的预后。

Effect of individualized whole course case management in community on quality of life of schizophrenic patients

Objective To explore the effect of individualized whole course case management in community on the quality of life and family burden in schizophrenic patients. Methods Eighty--two pa- tients with schizophrenia meeting International Classification of Diseases--10 （ICD--10） were enrolled in the study. They were randomly divided into two groups, study group （ n =41） and control group （ n = 41）. Patients in the study group received the individualized whole course case management, while those in the control group received the traditional outpatient follow--up treatment. The positive and negative syndrome scale （PANSS） was used to evaluate the psychiatric symptoms and rated twice a year from 2008. 1 to 2009.12. The quality of life and family burden of patients were evaluated by the Generic Quality of Life Inventory （GQOLI -74） and the Family Burden Schedule （FBS）,respectively. Both of them were rated at baseline and the end of second year. Results The total scores of GQOLI and the score on dimension of social function showed significant difference between two groups at the end of second year （t = 2. 015, P = 0. 048; t = 2. 387, P = 0. 020）. There were significant difference between two groups in terms of the four factors of sleep and energy, discomfortableness of body, life of entertainment and overall estimate of quality of life （P 〈 0.05）. In the study group, the total score of FBS and scores of two factors including the daily activities of family and family relation were significantly lower than those of control group （t = 3. 157, P = 0. 002; t =2. 538, P = 0. 013; t = 3. 002, P =0. 004）. Conclusions In developed inner city in China, the approach of individualized whole course case management could be used in schizophrenic patients from community. This approach made the best usage of the community re- sources and the advantage of inner city. It also integrated various kinds of treatment methods systemically on the basis of patient＇s individual condition and learn by case management model from foreign coun- tries. The patients were followed up through the whole course. So this approach could elevate the patient＇s quality of life and relieve family burden of disease. It could improve the prognosis of schizophrenia.