“医院-社区-一体化”管理模式对400例重性精神病患者精神康复的影响

目的：探讨＂医院-社区-一体化＂个案管理综合干预的模式对重性精神病患者防治康复效果。方法：有针对性的选取重性精神病患者800例,随机分为个案管理组400例和对照组400例。个案管理组即结合病人情况制定个性化方案,对其实施药物治疗、心理干预、工疗以及家庭护理等一种或多种手段进行综合社区康复治疗;对照组仅维持基本的药物治疗。分别使用临床印象总表疾病严重度（CGI-S）、个人和社会功能量表（PSP）评估个案管理组和对照组的病情改善和社会功能恢复情况,并统计治疗期间两组间复发情况和肇事肇祸发生率的差异。结果：1.在所有治疗评分节点,个案管理组CGI-S平均分都显著低于对照组（P〈0.01）;2.治疗终点时PSP减分方面,个案管理组达到（12.8±15.2）,而对照组为（4.9±17.1）。其中79.3%的病人改进了≥1个类别（以每10分为间隔进行分类）,与对照组的37.8%相比具有显著差异（P〈0.01）;3.相比于对照组高达51.50%的复发率,个案管理组复发概率更低（14.25%）;4.治疗期间个案管理组肇事肇祸率为4.75%,低于对照组18.75%。结论：＂医院-社区-一体化＂个案管理综合干预的模式能有效改善重性精神病患者的病情,减少复发风险,促进患者社会功能的恢复,显著降低肇事肇祸率。

Influence of ＂Hospital-community Integration＂ Management on Rehabilitation in Severe Psychoses

Objective：To investigate the effect of the ＂hospital -community integration＂ case management model on the prevention and rehabilitation of patients with severe psychoses. Methods ： targeted selection of 800 severe psychoses were randomly divided into case management group（N =400） and the control group（N =400）. Patients in the case management group were given personal- ized treatment , exerting one or more of rehabilitation therapic means of psychological intervention, work therapy and home care as the complement to drug treatment. The control group only maintained a basic medication. We used summary table of the Clinical Global Impression of disease severity （ CGI - S） , Personal and Social Performance Scale （PSP） to compare the difference between two groups of improvement and social function recovery. Meanwhile, the relapse rate and the making - trouble rate were assessed during the obser- vation period. Results ： （ 1 ） 1. In all treatment score node, average scores of CGI - S in case management group were significantly low- er than those in the control group （ P 〈 0.01 ） ; 2. At the end of treatment,PSP average minus points of the case management group was 12.8 -＋ 15.2, while the control group was only 4.9 ~： 17.1. Especially,79.3% of patients got improved ~ 1 categories （ defined every 10 points as a categories）, compared with 37.8% of the control group with significant differences （ P 〈 0.01 ） ; 3. In contrast to 51.50% of relapse rate in the control group, the probability of relapse in the case management group was lower to 14.25% ; 4. During treatment, making trouble rate of case management group was only 4.75% , which was much lower than 18.75% of the control group. Conclusions ： Hospital - community integration of case management model can effectively improve the condition of severe psychoses, reduce the risk of relapse, promote the recovery of social function and lower the rate of making trouble greatly.