上海某区医院-社区一体化康复模式对精神分裂症患者的效果(英文)

背景 精神分裂症患者远期疗效不理想的可能因素之一是住院治疗与社区精神卫生服务间缺乏连贯性。目的 评估医院-社区一体化康复模式对精神分裂症患者康复的疗效。方法 在上海市长宁区10家社区卫生服务中心参与医院-社区一体化康复计划的90例精神分裂症患者作为干预组,从长宁区社区普通管理的门诊精神分裂症患者中随机抽取52例患者作为对照组。由不了解患者分组情况的医生在入组(基线)和12个月后采用阳性与阴性症状量表(Positive and Negative Syndrome Scale,PANSS)、Morningside康复状态量表(Morningside Rehabilitation Status Scale,MRSS)评估患者情况。同时在上述两个时点采用家庭负担会谈量表(Family Burden Scale,FBS)、抑郁自评量表(Self-rating Depression Scale,SDS)、焦虑自评量表(Self-rating Anxiety Scale,SAS)和社会支持评定量表(Social Support Rating Scale,SSRS)评估患者法定监护人(绝大部分是与患者同住的家属)的情况。结果 入组时,PANSS评估结果显示两组的临床状况相仿,但是MRSS评估结果表明干预组的社会功能明显不如对照组。干预1年后研究组的临床症状和社会功能的改善程度均比对照组显著。1年中,研究组有3例(3.3%)住院,而对照组有6例(11.5%)(Fisher确切概率法,p=0.074)。无论是入组时还是1年后,两组监护人之间在感到的负担、抑郁、焦虑以及自我报告的社会支持等的差异均无显著性,但是干预组患者监护人的抑郁和焦虑症状在1年后得到改善。结论 医院-社区一体化康复模式能促进精神分裂症患者临床症状和社会功能的改善。今后需要进一步开展这一项目,来提高参与一体化康复模式的患者比例,并为患者家属提供更好的心理社会支持服务。

Effectiveness of a rehabilitative program that integrates hospital and community services for patients with schizophrenia in one community in Shanghai

BackEround： One possible reason for the less than satisfactory long-term outcomes for schizophrenia is the lack of coordination between inpatient and community-based services. Aim： Assess the effectiveness of a rehabilitation model for schizophrenia that integrates hospital and community services. Methods： Ninety patients with schizophrenia participating in an integrated rehabilitation program at 10 community centers in Changning, Shanghai （intervention group） and 52 community-based patients with schizophrenia randomly selected from all patients in Changning participating in routine outpatient care （control group） were assessed at enrollment using the Positive and Negative Syndrome Scale （PANSS） and the Morningside Rehabilitation Status Scale （MRSS） and then re-assessed i year later by clinicians who were blind to the group assignment of the patients. The patients＇ registered guardians （the vast majority were co-resident family members） were assessed at the same times using the Family Burden Scale （FBS）, the Self-rating Depression Scale （SDS）, the Self-rating Anxiety Scale （SAS） and the Social Support Rating Scale （SSRS）. Results： At enrollment the clinical status of patients in the two groups （assessed with PANSS） was similar but the social functioning measures assessed by MRSS were significantly worse in the intervention group than in the control group. After one year the improvement of both clinical symptoms and social functioning measures were significantly greater in the intervention group than in the control group. In the year of follow-up, 3 individuals （3.3%） in the intervention group and 6 individuals （11.5%） in the control group were re-hospitalized （Fisher Exact Test, p=0.074）. The feelings of burden, depression, anxiety and reported social support among guardians of patients in the intervention group were not significantly different from those for guardians of patients in the control group either at the time of enrollment or after the 1-year intervention. However, guardians in the intervention group showed a significant decrease in depressive and anxiety symptoms over the one-year follow-up. Conclusion： Rehabilitative approaches that integrate hospital and community services can improve clinical and social outcomes for patients with schizophrenia. Further development of these programs is needed to increase the proportion of patients who achieve regular employment （i.e., ＇community re-integration＇） and to provide family members with better psychosocial support.