佛山顺德区有肇事肇祸倾向重性精神疾病患者社区个案管理效果的干预12个月随访

目的:探讨社区个案管理对佛山市顺德区有肇事肇祸倾向的重性精神疾病患者社会功能、生活质量和家庭负担的影响。方法:将有肇事肇祸倾向的重性精神疾病患者分成干预组和对照组,对干预组实施个案管理模式,而对照组仅维持原来的社区随访服务。用简明精神病量表(BPRS)、社会功能缺陷筛查量表(SDSS)、Morning Side康复状态量表(MRSS)、生活质量量表和家庭负担会谈量表(FIS)评定两组患者的精神症状、社会功能、生活质量和家庭负担,并计算两组患者的肇事肇祸率。结果:在干预12个月后,干预组BPRS评分[(32.51±4.03)和(34.18±4.46)]、SDSS评分[(7.51±2.90)和(7.99±4.16)]、MRSS评分[(56.09±20.61)和(58.74±22.30)]和FIS量表评分[(35.20±10.31)和(37.28±14.24)]显著低于对照组(P0.05或P0.01),而干预组生活质量量表评分(13.32±4.75)显著高于对照组[(12.58±4.97)(P0.05)];干预组的肇事肇祸率(12.6%)显著低于对照组(18.2%,P0.05)。结论:对有肇事肇祸倾向的重性精神疾病患者实施个案管理,能有效改善患者的精神症状,降低肇事肇祸率,改善社会功能和生活质量,减轻患者的家庭负担。     

山东日照地区重性精神疾病患者管理治疗和肇事肇祸情况调查分析

目的:对山东日照地区重性精神疾病患者管理治疗状况和肇事肇祸情况进行调查分析。方法:对日照市城乡部分登记在册的重性精神疾病患者进行疾病分类管理并对肇事肇祸情况进行危险性评估。结果:重性精神疾病患者中未治疗的患者占26.34%、门诊治疗的患者占34.31%,住院治疗的患者占39.35%。患者中肇事肇祸发生率为82.37%,其中精神分裂症患者肇事肇祸最多。危险性评估为高风险患者占53.30%。结论:重性精神疾病患者治疗不足,肇事肇祸发生多,应该加强这一特殊人群的管理和治疗。     

南宁市兴宁区肇事肇祸重性精神疾病患者情况调查

目的:了解南宁市兴宁区重性精神疾病患者肇事肇祸情况及危险因素。方法:对登记在册的兴宁区712例重性精神疾病患者进行危险性评估,了解其有无肇事肇祸情况。结果:712例重性精神疾病患者中有肇事肇祸患者148例,占20.79%,其中精神分裂症患者中最多,占20.96%;肇事肇祸的发生与患者的性别、婚姻、家族史、服药依从性等原因有关。结论:需要针对高危的社区重性精神疾病患者加强监管和治疗。     

佛山市顺德区重性精神疾病患者肇事肇祸情况调查

目的了解佛山市顺德区重性精神疾病患者的肇事肇祸等情况。方法对登记在册的4107例重性精神疾病患者进行一般信息统计和基础情况调查,评估其危险性,了解其肇事肇祸情况。结果4107例重性精神疾病患者中,肇事肇祸患者共962例（23％）,肇事肇祸患者以精神分裂症（62％）最多见,并且具有男性（63．7％）为多、未婚和丧偶较多、经济状况较差、服药依从性差和阳性家族史较多的特点。结论要重视重性精神疾病患者的药物治疗,并建立有效的社区干预模式。     

农村重性精神疾病患者肇事肇祸情况调查

目的：了解农村重性精神疾病患者肇事肇祸情况。方法：从已登记的1427例农村重性精神疾病患者中调查有无肇事肇祸情况。结果：1427例中有肇事肇祸患者308例（21.6%）,其中以精神分裂症最多1067例（74.8%）。肇事肇祸的发生率与患者的性别、文化程度、诊断、监护人、病程、住院次数和服药依从性等有关。结论：对农村重性精神疾病患者的监护和治疗工作应引起充分重视。     

绵阳市游仙区农村重性精神疾病线索调查

目的调查西部经济欠发达地区农村重性精神疾病的肇事肇祸及其治疗状况．方法根据线索对绵阳市游仙区农村546例重性精神疾病患者进行调查．结果绵阳市游仙区农村重性精神疾病患者的肇事肇祸率达100％，肇事肇祸严重，诸如杀人、纵火、严重扰乱社会治安的肇事肇祸行为发生率高，自伤及自杀行为明显；从未就医者为20％；未住院者为43％；10年中未正规治疗的重性精神疾病患者占75％。结论西部经济欠发达地区的农村重性精神疾病的肇事肇祸发生率高，其治疗状况不容乐观。     

重性精神疾病管理治疗项目实施效果调查研究

目的 分析、评估重性精神疾病管理治疗项目实施效果.方法 通过一般状况调查表、危险性评估量表及阳性和阴性综合征量表(PANSS)、社会功能缺陷筛选量表(SDSS)、生活质量综合评定问卷(GQOLT-74)、精神卫生知识知晓率调查问卷,对潍坊市昌乐县1 500例患者实施项目前后,从精神疾病防治网络建设、治疗率与复发率、轻度滋事率与肇事肇祸率、社会功能与生活质量以及精神卫生知识知晓率等方面进行对比研究.结果精神疾病防治网络覆盖率由实施前的60％上升到100％;治疗率显著提高(P＜0.01),复发率、轻度滋事率及肇事肇祸率均显著下降(P＜0.01),实施前后PANSS、SDSS、GQOLI-74总分比较均有显著性差异(P＜0.01),精神卫生知识知晓率由实施前的38.2％上升到56.0％.结论 项目的实施对完善精神疾病防治网络建设、降低肇事肇祸率、改善患者社会功能等方面作用重大,重性精神疾病管理治疗项目值得进一步拓展与推广.     

社会工作者介入重性精神疾病社区服务的初步研究

目的分析上海市长宁区社会工作者介入重性精神疾病社区服务的状况。方法从组织架构、日常管理、实施效果等方面进行初步研究。结果长宁区精神卫生社工站采用民办非企业模式运作,为社区患者及家属等提供服务,包括建档立卡、个案服务、小组服务、便利服务、社区公益服务等。社工／服务对象比例为1：50,病种以精神分裂症、双相障碍等重性精神疾病为主,在管患者规范管理率达95．01％,稳定率达96．5％,肇事肇祸率为0。结论精神卫生社工服务模式整合多元资源,承接政府购买服务项目,一定程度上缓解社区供需矛盾,为在大中型城市推广实施提供了范例。     

社区医生督导对重性精神障碍患者服药依从性和疗效的影响

目的探讨社区医生督导对重性精神障碍患者的服药依从性及治疗效果的影响。方法选取于2013年2月2日至2015年2月1日期间居住于同一社区的重性精神障碍患者175例,对所有患者进行六级危险性评估,依据临床表现对所有患者作四级管理分类,并根据管理分类,为每位患者制定个性化社区医生督导方案。2年后,收集所有患者服药依从率、症状好转率、社区集体康复活动参与率、肇事肇祸率等资料,并与2年前进行对比。结果与管理前相比,患者服药依从率从59.1%上升到70.2%;社区集体康复活动参与率从27.3%上升到70.1%;肇事肇祸率从44.4%下降到11.4%,差异具有统计学意义(P0.01)。结论应用社区医生督导能有效提高重性精神障碍患者的服药依从性和疗效,对提高患者医疗效果有着积极作用。     

肇事肇祸精神疾病患者的临床特征及其相关因素研究

目的 探讨肇事肇祸精神疾病患者的临床特征及其相关因素.方法 对139例肇事肇祸精神疾病患者进行一般人口学、卫生经济学、相关因素调查及PANSS量表评定.结果 肇事肇祸患者以精神分裂症为主,其PANSS量表评分显著高于全国常模(P＜0.01).首发年龄低、病程短、住院次数少、男性、家族史阴性、家庭负担重、无医保支持、监护差是患者发生肇事肇祸行为的高危因素.结论 曾有精神异常史却因缺乏监管及经济支持而未能得到及时治疗的男性复发精神疾病患者易发生肇事肇祸行为.     

2013年荆门市重性精神疾病患者流行病学现状分析

目的 了解荆门市重性精神疾病患者的流行病学分布、生活状态、就医情况及影响因素,为开展公共卫生服务、社区防治工作提供依据.方法 以ICD-10和CCMD-3为诊断标准,向各乡镇卫生院、社区卫生服务中心下发统一的线索调查表,由精神科专业医生对可疑患者进行复核确诊,对2010~2013年纳入国家管理系统的重性精神疾病患者信息进行核对和整理,导出信息并与调查数据进行比较分析.结果 2010~2013年全市共管理重性精神疾病患者9612例,检出率为3.34‰;以精神分裂症(76.77%)为主,检出率为1.99‰;男女比例为1:1.125;患者以18~44岁的青壮年(54.23%)为主;婚姻状况以已婚(55.33%)为主;经济状况以贫困(63.31%)为主;文化程度以文盲(24.15%),小学(31.42%),初中(34.16%)为主;职业以农民(76.51%)及无业(20.89%)为主;病程多在10年以上;精神发育迟滞伴发精神障碍患者住院及治疗比例最低(28.78%);躯体疾病及并发症(66.15%)和意外事故(28.46%)为患者的主要死亡因素.结论 精神分裂症、精神发育迟滞伴精神障碍、双相(情感)障碍患者居荆门市重性精神疾病前3位,女性多于男性,年龄集中在18~45岁,已婚比例低,离婚及丧偶比例高,文化程度低,患者经济负担重,病情迁延,治疗负担重,建议加强和完善各级防治网络建设及社区精神卫生服务,加强重性精神疾病患者的管理,加大政府及公益资金投入.     

Enhancing employment services for people with severe mental illness: the challenge of the Australian service environment

OBJECTIVES: Comparatively few people with severe mental illness are employed despite evidence that many people within this group wish to obtain, can obtain and sustain employment, and that employment can contribute to recovery. This investigation aimed to: (i) describe the current policy and service environment within which people with severe mental illness receive employment services; (ii) identify evidence-based practices that improve employment outcomes for people with severe mental illness; (iii) determine the extent to which the current Australian policy environment is consistent with the implementation of evidence-based employment services for people with severe mental illness; and (iv) identify methods and priorities for enhancing employment services for Australians with severe mental illness through implementation of evidence-based practices. METHOD: Current Australian practices were identified, having reference to policy and legal documents, funding body requirements and anecdotal reports. Evidence-based employment services for people with severe mental illness were identified through examination of published reviews and the results of recent controlled trials. RESULTS: Current policy settings support the provision of employment services for people with severe mental illness separate from clinical services. Recent studies have identified integration of clinical and employment services as a major factor in the effectiveness of employment services. This is usually achieved through co-location of employment and mental health services. CONCLUSIONS: Optimal evidence-based employment services are needed by Australians with severe mental illness. Providing optimal services is a challenge in the current policy environment. Service integration may be achieved through enhanced intersectoral links between employment and mental health service providers as well as by co-locating employment specialists within a mental health care setting.     

A randomized controlled trial of integrated versus parallel housing services for homeless adults with severe mental illness

This study compared two contemporary approaches to linking housing and mental health services. In the integrated housing program, case management and housing services were provided by teams within a single agency and were closely coordinated. In the parallel housing condition, case management services were provided by mobile assertive community treatment teams and housing by routine community-based landlords. Adults with severe mental illness who were at high risk for homelessness (n = 121; 72.7% schizophrenia spectrum) were assigned randomly to integrated or parallel housing services and followed for 18 months. Integrated housing services led to more days of stable housing and greater life satisfaction than parallel housing services, especially for male participants. Integrated housing services were also associated with greater reductions in psychiatric symptoms. Closer integration between clinical and housing services, and greater use of supervised living settings, led to more time in stable housing for participants in the integrated housing services condition and was associated with greater gains in several outcome domains.     

2011年四川省在库重性精神疾病分析

目的了解四川省重性精神疾病的基本情况,旨在为四川省重性精神疾病社区管理治疗工作提供技术指导。方法依据国家公共卫生服务均等化重性精神疾病管理治疗服务规范及工作规范和国家数据收集分析系统的要求制定工作方案,开展全省精神卫生机构、疾病预防控制机构及社区卫生服务中心和乡镇卫生院相关人员技术培训,按照工作方案的要求于2010年7月在全省范围内启动重性精神疾病摸底调查,资料完整者录入国家数据收集分析系统,再将2011年12月末四川省各市州录入国家重性精神疾病数据收集分析系统的数据导出进行统计分析。结果截止2011年12月末,四川省共调查出重性精神疾病119313例,同意并实施网络管理的重性精神疾病54700例,管理率为45.85%。本次显示四川省重性精神疾病患者经济状况处于当地贫困线以下为61.77%;文盲和半文盲为31.87%,小学文化为37%;农村重性精神疾病为80.8%,城市无业人员为5.46%;重性精神疾病未婚率为31.01%,离婚率为4.21%;重性精神疾病患者间断服药和不服药者分别为27.9%和33.5%;重性精神疾病患者危险行为发生率为21.56%,其中肇事、肇祸发生率为7.84%。结论我省重性精神疾病患者社会、经济地位十分低下,对社会、家庭的危害及潜在危险极大,需进一步探索和改变现有的管理治疗模式,以维护社会的和谐稳定。     

Employment services as an early intervention for young people with mental illness

Aim: To examine the service characteristics and effectiveness of a segregated employment service assisting young clients with mental illness in New Zealand. Methods: The service assisted both youth and adults with severe mental illness to find and keep competitive employment. A retrospective case study method was used to examine service effectiveness with respect to employment outcomes attained by 49 clients aged 16–25 years over a 2-year period (2005–2007). These results were compared with recent national and international benchmarks. Results: As a service segregated from public mental health services, there were no formal arrangements with local mental health teams, limiting coordination of services and reducing fidelity to evidence-based practices in supported employment. Despite an inability to collaborate closely with local community mental health services and a contract not specifically targeting youth, the service was high performing on a range of employment outcome variables. Conclusions: Subject to some study design and benchmarking limitations, these results support the continuing use of evidence-based practices in supported employment and supported education as important early interventions for young people with mental illnesses.     

甘肃省70538例居家重性精神疾病患者管理效果评价

目的掌握甘肃省重性精神疾病患者居家管理的干预现状,并对管理效果做出评价,为今后对重性精神疾病患者更好地进行社区康复管理、救治救助奠定基础。方法依据重性精神疾病管理治疗工作规范(2012年版)和国家基本公共卫生服务规范(2011年版),对甘肃省2015年1月至2016年4月期间,通过普查和线索调查筛查出疑似患者并确诊,然后进行随访,进一步收集和分析其接受随访管理(在管)、治疗、服药、危险行为发生情况等信息。结果甘肃省共计确诊重性精神疾病患者70538例,其中在管患者占81.08%(57195例)。在管、非在管和失访的重性精神疾病患者中,治疗率为69.92%(48009/68663),其中双相情感障碍的治疗率(76.00%)最高(均P0.001)。在管居家患者的服药率为42.16%(24113/57195),规律服药率为24.74%(14150/57195),其中偏执性精神病的服药率(51.98%)最高(均P0.001),癫痫所致精神障碍的规律服药率(31.02%)最高(均P0.001)。结论目前甘肃省重性精神疾病居家管理率、治疗率、在管居家患者的服药率和规律服药率均低于全国平均水平,在普及精神疾病防治知识和提高医务人员对重性精神疾病规范化治疗能力等方面需大力加强。     

Fidelity of supported employment programs and employment outcomes

This study attempted to identify critical components of a supported employment program that were strongly correlated with competitive employment outcomes in a state mental health system. Researchers used a supported employment fidelity scale to rate programs at ten community mental health centers in Vermont. The staff at the centers concurrently assessed competitive employment outcomes for 2,639 clients who had been diagnosed as having severe and persistent mental illness. Higher competitive employment rates were strongly correlated with overall program fidelity and with two program components, namely, providing services in the community as opposed to providing them in the clinic and using full-time employment specialists as opposed to staff with mixed roles.     

重性精神疾病社区管理服务背景下湛江地区患者及家属对疾病知晓情况的分析

目的了解社区服务背景下湛江地区重性精神疾病患者及家属对疾病的知晓情况及社区服务效果,以促进人们对疾病的认识,指导社区服务与管理。方法随机选取湛江地区三家医院,整群随机抽取2018年3月-10月新入院并符合《国际疾病分类(第10版)》(ICD-10)诊断标准的重性精神疾病患者481例及对应的家属481例为研究对象,自编严重精神障碍患者暴力行为危险因素调查问卷调查患者及其家属对疾病的知晓程度、主要的知晓途径、知晓率。结果患者及家属精神卫生知识知晓率分别为64. 5%和65. 8%,组间差异无统计学意义(P>0. 05)。患者与家属之间的知晓程度构成差异有统计学意义,家属对疾病的知晓程度更高(P<0. 01)。而对疾病知晓的主要途径方面,患者和家属均以就诊或住院的医院为主,分别占92. 3%和92. 7%。结论现阶段湛江地区患者及家属对重性精神疾病的知晓程度偏低,社区服务未能成为最主要的知晓途径。     

A case report of the conversion of sheltered employment to evidence-based supported employment in Canada

This case report describes the transformation of a sheltered workshop program to a program that provides evidence-based supported employment services in partnership with five community treatment teams. Over a 15-year period, a Canadian nonprofit agency that provides employment services for persons with severe mental illness made a series of programmatic changes to increase the effectiveness of the services. The agency initially modified its facility-based sheltered workshop to include a prevocationally oriented work preparation program, later added brokered supported employment services, and finally completely transformed its organization by relocating its vocational rehabilitation counselors to five community mental health teams, in order to implement an evidence-based supported employment program that is based on the individual placement and support model. During the initial period in which the sheltered employment program was utilized, less than 5 percent of clients who were unemployed when they entered the workshop achieved competitive employment annually. The annual competitive employment rate did not increase during the prevocational phase; it increased during the brokered supported employment phase but did not exceed 25 percent. By contrast, after shifting to evidence-based supported employment, 84 (50 percent) of 168 unemployed clients who received between six and 27 months of individual placement and support services achieved competitive employment. This article also documents the role of agency planning and commitment quality improvement in implementing change.     

Severely Mentally Ill Patients with and Without Substance Use Disorders: Characteristics Associated with Treatment Attrition

We aimed to describe characteristics associated with attrition for patients in community mental health treatment with chronic mental illness with and without substance use disorders. Baseline assessments included symptom severity, treatment satisfaction, social support, and a structured diagnostic interview. Treatment attrition was assessed at six months. At six months, 36% of the dual diagnosis group (n = 25), and 61% of the mental illness alone group (n = 23) were lost to follow-up. Attrition in the dually diagnosed group tended to be associated with less satisfaction with treatment, and higher mean symptom scores. There were no characteristics associated with attrition in the group of patients with mental illness alone. However, client satisfaction tended to increase among the mental illness alone patients that were successfully followed. The dually diagnosed group that remained in treatment had a significantly lower mean treatment satisfaction score than the mental illness alone group at six months. This type of investigation should aid in patient care and evaluation of treatment programs for persons with severe mental illness and co-occurring substance use disorders.