汕头市精神分裂症社区康复疗效分析

目的探讨精神分裂症社区康复的疗效和方法。方法对１２３例精神分裂症２年社区康复的治疗、现病、社会功能、社会影响、复发进行前后比较，并与７９例社区自然状态下精神分裂症对照。结果精神分裂症两年社区康复疗效显著，２年显进率达７３９８％，复发率１７５８％，对照病例则无变化或恶化，显进率２９１１％，复发率４３４８％。结论社区康复对于精神分裂症控制病情，恢复社会功能，防止复发显示明显作用     

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。     

长程住院对精神分裂症患者社会功能消极影响的研究

目的：探讨长程住院对精神分裂症患者社会功能的消极影响。方法：用社会功能缺陷量表（ＳＤＳＳ）地连续住院６个月的精神分裂症患者出院３天，３月和６月的社会功能进行测评。结果：患者社会功能缺陷发生率为１００％，其严重程度与住院环境、住院时间相关，出院初期、３月、６月其社会功能总体水平存在极显著差异。结论：长程住院不利于２全面康复及日后回归社会、应加强“非住院化”治疗及家庭教育等社区康复工作。     

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。     

社区家庭干预对精神分裂症患得及家属的作用

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。     

精神分裂症患者社区治理效果及影响因素分析

目的 探讨社区精神分裂症分区化管治效果及影响因素。方法 对278例社区精神分裂症患者实施分区化管治，分析管治前后的治疗情况、病情变化、社会功能、社会影响和社会危害，并分析管治效果的影响因素。结果 分区化管治效果显著，规则治疗率由29．5％提高到92．1％，总有效率由46．4％提高到97．1％；影响管治效果的因素依次为康复时间、病程、初次治疔时的疗效、服药依从性和药物副作用。结论 分区化管治有利于社区精神分裂症的康复；康复时间短和病程长是康复效果差的主要影响因素。     

精神病妇女妊娠期、产后病情及治疗

通过对２１４例女精神病人妊娠期，产后病情及治疗的研究，发现精神分裂症妊娠期未服药者，复发率１５．３８％，服药者未见复发，存有症状者１７．６５％病情加重。躁郁症，癔病妊娠期未见复发者。产后３个月内，精神分裂症、躁郁证、癔病总波动率（复发＋加重），三者间无明显差异（Ｐ＞０．０５）。对妊娠期、产后的治疗及对母亲、胎儿、婴儿健康的影响进行了讨论，提出合理妊娠，用药的建议。     

家庭干预对精神分裂症康复效果的对照研究

目的探索家庭干预对精神分裂症的康复效果。方法对５０例精神分裂症病人及其家庭成员进行家庭干预，并以５０例单一药物治疗精神分裂症病人作对照。结果一年后实验组的复发率为１４％，显著低于对照组（４４％），同时ＤＡＳ总分也明显下降。结论家庭干预不仅可减少精神分裂症的复发率，且有助于社会功能的改善。     

46例精神分裂症患者家庭康复治疗分析

本文对４６例精神分裂症患者进行了较系统的家庭康复指导措施。着重以家庭关系、家庭参预意识、社会适应能力及人际关系、服用维持性药物、社会功能状况等方面入手。随访三年结果表明，家庭关系好者３２例（６９．５％），康复２６例（８１．３％）。重视和合理安排家庭生活３１例（６７．４％），康复２５例（８０．６％）。社会适应能力改善，社会关系好者２９例（６３％），康复２４例（８２．７％）。坚持按医嘱服药维持治疗３６例（７８％），康复２８例（７７．８％）。社会功能康复者２８例（７７．８％）。认为开展家庭康复治疗对精神分裂症患者早日回归社会，有着十分重要的作用。     

利用网络防治精神分裂症复发对照研究

目的：探讨网络对非急性期精神分裂症患者的作用。方法：选取71例非急性期精神分裂症患者随机分为两组,数字化网络组（数字化网络配合社区防治网）35例,社区防治组36例（由社区防治网随访）。最后完成62例。在药物治疗的基础上,对数字化网络组患者进行网上心理咨询,社区防治组进行一般康复干预。随访1年。应用阳性与阴性症状量表（PANSS）、社会功能缺陷筛选量表（SDSS）进行评估,同时监测其复发率和药物依从性。结果：随访结束时PANSS各量表的评分数字化网络组均显著优于社区防治组（P〈0.01）。数字化网络组1年复发恶化率低于社区防治组（P〈0.05）。药物依从性和社会功能数字化网络组均显著优于社区防治组（P均〈0.01）。结论：在药物治疗的基础上,利用数字化网络配合社区防治网对精神分裂症患者预防复发,改善社会功能有明显作用。     

Two-year outcomes of psychosocial rehabilitation of black patients with chronic mental illness

OBJECTIVE: Outcome as measured by psychosocial functioning was examined in a two-year follow-up study of 46 patients with chronic mental illness, 44 of whom were African American, who participated in an intensive psychosocial rehabilitation program based in a community mental health center. METHODS: Patients attended a program that operated seven days a week in a predominantly urban, black section of Baltimore. Level of functioning was determined at baseline and at six and 12 months using a scale based on data from the 1972 International Pilot Study of Schizophrenia. Parameters assessed included the length of time patients stayed out of the hospital, the frequency and depth of social relationships, dysfunction in work, the presence of symptoms, the ability to maintain personal hygiene, and the ability to participate in leisure activities. RESULTS: The sample was divided into three diagnostic groups: patients with schizophrenia alone (N=27), patients with a mood disorder (N= 12), and patients with a dual diagnosis of schizophrenia and a substance use disorder (N=7). Scores on the level-of-functioning measure were significantly correlated between baseline and six months, between six months and 24 months, and between baseline and 24 months. Statistical tests indicated a substantial and significant increase in level of functioning from baseline to 24 months for all groups. CONCLUSIONS: The results provide evidence for the effectiveness of an intensive psychosocial rehabilitation program for urban, black patients with chronic psychiatric illness, including those with a dual diagnosis.     

Cognitive predictors of psychosocial functioning outcome in schizophrenia: a follow-up study of subjects participating in a rehabilitation program

The aims of this prospective study were to explore in subjects with psychosis participating in a rehabilitation program whether cognitive performances at baseline predicted (i) psychosocial functioning over a 15-16 month follow-up; (ii) improvement in psychosocial functioning over the rehabilitation program. Visuo-spatial tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were administered to assess cognitive performance in 55 subjects with schizophrenia spectrum disorders who completed a rehabilitation program. The Multnomah Community Ability Scale (MCAS) was used to measure dimensions of community functioning. One subscale of the Client's Assessment of Strengths, Interests, and Goals (CASIG) provided a measure of subjective quality of life (QoL). Improvement was defined as a 15% or more increase in psychosocial scores between baseline and follow-up. Worse baseline sustained attention predicted better self-rated quality of life, and better baseline visual memory predicted better community functioning over the rehabilitation follow-up period, in particular, higher autonomy in activities of daily living, and less physical and psychiatric symptoms that could interfere with rehabilitation. Baseline cognitive performances predicted community functioning improvement during the follow-up period: visual memory predicted improvement in daily living autonomy and in social competence; sustained attention predicted improvement in behavioral problems (such as medication compliance, collaboration with treatment providers or impulse control) and social competence; planning performances predicted improvement in social competence. These cognitive functions could be specifically targeted in a rehabilitation program aimed at enhancing functioning in those particular dimensions.     

Community rehabilitation service for patients with severe psychotic disorders: the Slovene experience

BACKGROUND: Rehabilitation can be carried out at various sites. METHOD: Two groups of patients with severe mental disorders were compared: those included in community rehabilitation service and those only attending an outpatient clinic regarding their clinical status, social functioning, standard of living and quality of life. RESULTS: We found no significant global differences in group characteristics, social functioning and clinical status, but we did prove the lower social status of the group included in the rehabilitation service and their satisfaction with the services they use. CONCLUSIONS: The community rehabilitation services in Slovenia are coping with existential social needs of their users but this study failed to demonstrate their success in improving health or social functioning.     

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。     

501例社区中精神分裂症患者现状分析

对列为社区康复对象的５０１例精神分裂患者现状调查。发现此类病人病情较重。病程长，迁延不愈，反复发作，精感衰退，治疗状况差，家庭经济困难，是精神疾病社区康复的重点对象。     

Baseline personality functioning correlates with 6 month outcome in schizophrenia.

OBJECTIVE: The assessment of outcome in schizophrenic patients should consider both the response to treatment and the recovery of social skills. The aim was to evaluate the outcome and related psychostructural and clinical factors in schizophrenic patients after they underwent 6 months of residential multimodal treatment. METHOD: Fifty-two schizophrenic patients enrolled in a multimodal treatment program were included in the study. Symptomatology and social functioning were assessed with the Brief Psychiatric Rating Scale (BPRS) and the Social and Occupational Functioning Assessment Scale (SOFAS). The Karolinska Psychodynamic Profile (KAPP) was used for the psychostructural evaluation. RESULTS: After 6 months there was a significant improvement in the global scores of BPRS, SOFAS, and some areas of KAPP. The personality (KAPP) and social-occupational functioning (SOFAS) at baseline (T0) correlated with the global score of BPRS at 6 months (T6); moreover, SOFAS at T6 correlated with BPRS and KAPP at T0 and with the illness duration. CONCLUSION: The better the personality functioning in schizophrenic patients the better seems to be the response to treatment, with regard to symptoms as well as rehabilitation. Personality assessment might be useful for the individualisation of therapies, even within the context of a standardised program.     

Deinstitutionalization for long-term mental illness: a 6-year evaluation

OBJECTIVE: Forty-seven patients with long-term mental illness were transferred to the community following the closure of a psychiatric hospital in Sydney. This 6-year evaluation is an extension of a detailed clinical, ethnographic and economic study of the initial 2-years of community transition. METHOD: Quantitative evaluation was conducted using the Brief Psychiatric Rating Scale, Life Skills Profile, Social Behaviour Scale, Montgomery Asberg Depression Rating Scale and Quality Of Life measures. Assessments were completed prior to discharge and at two- and 6-year intervals following community transfer. Repeated measures analysis was utilized to determine changes in outcome variables over time. The residents' perception of 6-years of community living was explored in qualitative semistructured interviews. Details of accommodation, level of care, readmissions, incidents and medication were also documented. RESULTS: During the 6 years following community relocation a total of seven residents returned to hospital for long-term care, three residents died from medical causes and one resident required detention in a corrective services facility. The 36 residents who remained in the community at the 6-year follow-up no longer required intensive 24-h supervision. Living semi-independently, 23 residents resided in two to three person accommodation with either daily or weekly case manager visits. Clinically, community residents remained stable over the 6 years without significant changes in psychiatric symptoms, depression, living skills or social behaviour problems. Clinical stability was achieved with significant reduction in medication levels over the 6 years. Community-based residents continued to experience improved quality of life and reported their marked preference for living in the community. CONCLUSION: The residents maintained community tenure with significant improvement in quality of life and a reduction in medication, supported by a mental health system with adequate community resources. Issues regarding continuing rehabilitation and social integration need to be addressed. Further deinstitutionalization will require 24-h supervision for most initially and for some on a continuing basis. An ageing population will require specific age related medical and psychiatric services.     

Intensity and continuity of services and functional outcomes in the rehabilitation of persons with schizophrenia

OBJECTIVE: The intensity and continuity of services delivered to individual clients in a community-based psychosocial rehabilitation program were examined in relationship to functional changes in the clients that occurred during the first 12 months of the program. METHODS: Subjects were 41 clients with schizophrenia or schizoaffective disorder who were admitted to an intensive psychosocial rehabilitation program. Measures of clinical and psychosocial functioning were derived from client interviews administered at baseline and six and 12 months later. Measures of service intensity and continuity came from data gathered daily by staff over 12 months. RESULTS: The results supported the hypotheses that greater intensity and longitudinal continuity of services are related to more client improvement as indicated by reduced rates of hospitalization and improved psychosocial functioning after both six and 12 months. Although clients' symptom levels increased over time, a significant relationship was noted between service intensity and continuity and better symptom outcomes after 12 months. Multiple regression analyses indicated that an average of 22 percent, and as much as 28 percent, of the change in clinical and functional outcomes after 12 months of rehabilitation was explained by the intensity and longitudinal continuity of services. CONCLUSIONS: Clients who received more contact hours with staff and who had fewer gaps in service delivery achieved greater rehabilitative improvement in social, work, and independent-living domains and had fewer days of hospitalization. Based on these findings, clinicians, administrators, and researchers can assume that the intensity and longitudinal continuity of services are important to achieving rehabilitative outcomes in some community-based psychosocial rehabilitation models.