社区重性精神疾病的管理及治疗现状

通过社区摸底调查,建立重性精神病患者健康档案,对重性精神病患者进行追踪随访,对贫困重性精神病患者免费发药等规范管理,观察社区精神病患者康复效果,调查、普及精神病相关知识,提高患者对治疗的依从性,减少病情复发,减少肇事肇祸,促进患者的社会功能康复,从而降低精神病造成的家庭和社会的负担,促进社会和谐。对确诊的所有登记的社区重性精神病患者进行规范化管理及用药、康复指导。加强社区重性精神病规范管理及时合理用药康复指导可有效控制精神病复发     

社区康复管理模式在江北区重性精神病患者中的应用效果

目的：评价社区康复管理模式在江北区重性精神病患者中的应用效果。方法2012年5月1日~12月31日,将社区中登记、并已建档立卡的1271例重性精神病患者进行疾病分类,以社区医疗康复团队对患者进行跟踪随访,开放式康复训练,以责任制形式制订社区康复管理工作模式,并在社区中应用。结果社区康复管理模式对患者在自知力恢复、提高依从性,降低疾病复发率方面有明显效果。患者肇事、肇祸率、危险分级均明显降低,患者的社会功能得到一定提升。结论加强重性精神病患者社区康复管理工作对改善患者的社会功能,减少肇事、肇祸具有明显效果。     

某区农村重性精神病患者发病及管理治疗状况的调查分析

目的了解綦江区农村重性精神病患者现状。方法 2010年8月¹0月,通过对綦江区20个街镇疑似精神病患者进行排查,共筛查出重性精神疾病1079例,其中高风险患者690例,占64%。结果患者大部分为农村患者,家庭经济较差。重性精神病患者肇事肇祸,社会危害性大,必须加强社区系统管理治疗。结论根据綦江区重性精神病患者特点,对加强重型精神病患者的治疗和管理,维护社会稳定具有重要意义。     

重性精神病管理426例不同随访方法的对照分析

目的分析不同随访方法在重性精神病管理中效果。方法对426例参与管理的重性精神病患者随机分为传统走访组210例和传统走访、电话随访、间接随访等多形式随访组216例，比较两组患者在治疗依从性、药物疗效、肇祸肇事危险度、家属满意度、社会适应功能状况五项指标，药物疗效采用简明精神病评定量表（BPRS）评估，肇祸肇事等级采用重性精神病管理686-VII期项目肇祸肇事危险分级评估法评估、社会适应功能采用社会适应功能评估量表（SAFE）评估。结果多形式随访方法在治疗依从性、药物疗效、肇祸肇事危险度、家属满意度、社会适应功能等方面都与对照组有显著性差异（P〈0．05）。结论多形式随访方法对重性精神病管理效果更好。     

社区重性精神患者攻击行为的识别与对策

目的总结探讨社区重性精神患者攻击行为的识别与对策。方法对本社区2006年4月至2013年7月社区管理的重性精神患者随访观察和记录结果。结果 56例重性精神病患者经过随访观察和治疗,病情不稳定11例(其中自杀2例,纵火2例,3级7例),占19.6%,病情基本稳定39例,占69.6%,病情稳定者6例,占10.7%。结论识别社区重性精神患者的攻击行为,采取有效对策,降低危害社会治安行为的发生,可有效提高社区精防医师的应急处理能力。     

常熟市失地农民社区重性精神病现况调查

目的:调查失地农民社区重性精神病的现状。方法:2010年8月在常熟市江枫苑社区对精神疾病现状进行调查。结果:调查共发现重性精神病患者23例,其中精神分裂症20例,双相障碍3例。患者大部分文化程度低,95.7%的患者为无业状态,家庭经济较差。肇事肇祸风险与患者早年是否有虐待史、患者的服药情况、患者交流困难、自语自笑、孤僻懒散等症状有相关性。结论:根据失地农民社区中重性精神病的特点,应该制定相对应的防治管理制度,以便更好地开展重性精神病的防治管理工作。     

社区重性精神病患者危险性风险评估及干预对策

目的探讨外界综合干预对社区重性精神病患者危险性风险的影响和意义。方法对重庆市北碚区建档并居家的1 438例精神病患者进行社区走访,重点抽取200例有重度肇事、肇祸行为的重性精神病患者进行综合干预,干预后采用功能量表评定患者的功能状况。结果综合干预显著改善了重度肇事、肇祸行为的重性精神病患者的精神病性症状,危险性评估等级降低,肇事、肇祸行为发生率明显减少。结论开展社区重性精神病患者服务时应进行综合干预。综合干预对降低重性精神病患者的危险性、提高患者和家庭的生活质量、维护社会稳定具有重要意义。     

河北重性精神疾病管理示范区综合治疗前后危险性行为对比分析

自2007年开始,河北省开展了中央补助地方重性精神疾病管理项目（以下简称686项目）的治疗项目,3年来取得了良好的效果。现对3年来有肇事肇祸（危险性行为）行为的精神疾病患者进行治疗前与治疗后的对比分析,以探讨重性精神疾病患者的肇事肇祸率下降以及患者的依从性,从而有效达到患者在社区维持治疗目的,并且预防和降低精神病患者危险性行为发生。     

改良无抽搐电休克治疗重性精神病59例临床观察

目的探讨改良无抽搐电休克治疗重性精神病的临床疗效。方法回顾性分析了我院2013年1月至12月期间接受的改良电休克治疗的59例重性精神病患者及采用普通治疗方案的59例患者为对照组,对所有患者的临床资料进行总结及治疗效果的分析。结果总有效率实验组为91.53%,对照组为53.56%,治疗效果最好的为抑郁症实验组达到100%,躁狂症位于第二达到(92.3%),最后为精神分裂症(82.3%),实验组明显高于对照组。结论改良电休克治疗重性精神病是一种安全且有效的治疗方法之一,该治疗手段值得在精神科进行推广及应用。     

罗定市重性精神病疾病管理效果分析

目的评估、分析罗定市重性精神疾病管理效果。方法选取罗定市重性精神疾病患者病情不稳定或基本稳定(危险性评估等级1~5级)的精神分裂症患者共125例作为研究对象,在实施重性精神疾病管理治疗工作前和后(3年)分别使用一般状况调查表、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)进行管理前后对比研究。结果实施管理3年时与管理前比较,125例患者的危险性评估等级下降(P0.01),实施前后PANSS、SDSS总分比较均有显著性差异(P0.01)。结论重性精神疾病管理治疗工作对控制精神疾病患者危险性行为,减少患者社会功能缺陷,改善患者精神病性症状,促进患者社会康复的效果是明显的,此项工作值得进一步发展和推广。     

The influence of treatment attendance on subsequent aggression among severely mentally ill substance abusers

The interrelationships between severe mental illness, substance use, and aggression are of longstanding importance with implications for community treatment programs, treatment research and public policy. Through the analysis of longitudinal data collected from 278 patients over a 6-month period following admission to an outpatient dual diagnosis treatment program, this study examined the association between dual diagnosis treatment attendance and subsequent aggression among individuals diagnosed with both a severe mental illness and a substance use disorder. We also tested substance use and psychiatric symptoms as mediators of this treatment–aggression relationship. The results of structural equation modeling analyses indicated that dual diagnosis treatment was associated with lower levels of subsequent aggression. Mediational analyses indicated that greater treatment involvement was associated with reduced substance use, which was associated with lower levels of aggression; thus, substance use was found to mediate the relationship between dual diagnosis treatment and aggression. Surprisingly, severity of psychiatric symptoms did not predict later aggression. These findings suggest that targeting substance use reduction in treatment may have the additional benefit of reducing the risk of later aggression among dual diagnosis patients.     

Supporting patients with mental illness: Deconstructing barriers to community pharmacist access

Objectives

To discuss the barriers faced by individuals with mental health conditions attempting to access their community pharmacists and to propose solutions toward deconstructing those barriers.

无抽搐电休克治疗精神病患者的临床疗效分析

目的探讨无抽搐电休克治疗精神病临床疗效情况。方法采用回顾性分析的方法,分析为我院收治精神病患者60例临床资料,采取无抽搐电休克治疗。结果精神病患者治疗前后心率、血压生命体征变化无明显差异,精神病患者治疗后阳性症状、阴性症状、精神病理及总分均明显优于治疗前,P<0.05,差异均有统计学意义。治愈:15例(25%)、显效:20例(33.3%)、有效:21例(35%)、无效:4例(6.7%),总有效率93.3%。结论无抽搐电休克治疗为临床治疗精神病开辟了新道路,而且为总结科研提供了真实可靠的依据,值得精神科推广使用。     

Evaluation of a behavioural weight management programme for patients with severe mental illness: 3 year results

Excess weight is a common problem in the general population and in those with severe mental illness and is associated with a range of adverse consequences. The evidence base for managing excess weight in those with severe psychiatric illness is small. We report the outcome of a weight management programme provided in a community mental health centre. The programme consisted of group sessions, held weekly and lasting one hour. Participants self-referred and attended as many sessions as they wished. Sessions included weighing, feedback from participants and education on a range of issues including healthy eating and exercise. Over a 3-year period 70 patients, predominantly with schizophrenia, attended the programme. Length of follow-up ranged from 2 weeks to 3 years. Data for all 70 patients was evaluated. The mean BMI at entry to the programme was 32.5 kg/m2. The mean number of sessions attended was 34. Patients achieved a mean weight loss of 4.97 kg. The mean BMI at last attendance was 30.7 kg/m2. Weight loss correlated with number of sessions attended (p = 0.0001). This study demonstrates the long-term value of a weight management programme at 3 years and supports the hypothesis that weight loss can be achieved using a simple behavioural intervention in motivated psychiatric patients.     

Combining behavioral and self-help approaches in the inpatient management of dually diagnosed patients

The combination of a token economy and a self-help model made it feasible to organize and maintain an intensive dual-diagnosis treatment program in a public municipal hospital acute psychiatric ward. The program described here, which integrates the token economy and 12-step approaches, fosters voluntary and active patient participation in the process of simultaneous recovery from mental illness and addiction; it also networks the patient with community resources. Implementation of the clinical program involved addressing multiple clinical and organizational obstacles, including a multihandicapped and often nonmotivated patient population, a lack of psychiatric staff trained in managing substance abuse, and the need to integrate mental health with substance abuse clinical interventions. The program has been operating more than 5 years and has treated more than 1,000 patients. As the token economy became an integral part of the ward routine, violence on the ward declined substantially, and patient participation in group activities increased significantly.     

Integrated versus parallel treatment of co-occurring psychiatric and substance use disorders

The study examines 1-year treatment outcomes of 216 individuals with co-occurring severe and persistent mental illness and substance use disorders who were assigned to an integrated or parallel treatment condition. Comparisons indicated that the integrated group achieved greater reductions in the incidence of psychiatric hospitalization and arrest. The results of this study support the enhanced effectiveness of integrated treatment in decreasing the use of higher cost crisis-oriented services in clients with severe mental illness and substance use disorders.     

人性化心理护理在精神病患者住院治疗中的作用

目的：探讨人性化心理护理在精神病患者住院治疗中的作用。方法：按照随机数字法将58例患者随机分为观察组和对照组,其中对照组给予常规基础护理及精神科专科护理,而观察组则在对照组的基础上实施人性化护理。结果：观察组SANS、NOSIE评分在人性化护理前后有明显变化,且与对照组相比有明显差异（P〈0.05）。结论：人性化护理服务符合以人为本的现代护理理念,能够改善精神分裂症患者的病情,改善患者的依从性,恢复和改善社会功能,不仅可以提高护士本身的人文素质,还可以提高护理质量,缩短有效控制疾病的时间,不失为一种良好的护理方法。     

The Epidemiology of the Comorbidity of Psychiatric and Addictive Disorders:

Assessing the prevalence of the comorbidity of psychiatric and addictive disease using epidemiologic methods results in artifactually high rates. Use of a clinical sample will yield falsely high rates, because substance use is associated with exacerbation of mental illness. Cross sectional design will inflate rates of psychiatric comorbidity in addicts, who attribute substance use to psychological symptoms until well into recovery. Application of exclusionary criteria for independent diagnosis is subject to investigator bias, particularly about the unproven yet popular "self-medication" hypothesis. The psychiatric symptoms which are common in active addiction generally clear within weeks to months of treatment for addiction but do not respond to standard psychopharmacologic treatment for primary mental illness. When lengthy follow up periods are employed, substance induced psychiatric syndromes typically resolve. We conclude that while patients treated in psychiatric settins often have comorbid and independent addictive illness, patients treated in addiction settings uncommonly have comorbid psychiatric illness despite common psychiatric symptoms.     

Assessing Comorbid Substance Use in Detained Psychiatric Patients: Issues and Instruments for Evaluating Treatment Outcome

This review assesses the issues involved in the selection and treatment of patients comorbid for mental illness and substance misuse being treated in secure psychiatric facilities. It includes those individuals who have a history of offending and whose placement is the result of severe behavioral disturbance. The relevant issues in the assessment and treatment of these patients are reviewed and a battery of tests is suggested on the basis of their usefulness with this population in terms of their brevity, ease of administration, and for their value in planning treatment, providing motivational feedback, and monitoring change. The paucity of assessment tools developed specifically for this patient population is highlighted.     

Ethical issues in schizophrenia: considerations for treatment and research

Clinicians who treat patients with schizophrenia may encounter a variety of ethical issues related to both psychiatric and medical treatment of patients. While informed consent is a crucial aspect of the care of all patients, it may present special challenges for patients with schizophrenia. Schizophrenia is a severe mental illness that is frequently accompanied by neuropsychological deficits. These impairments, as well as psychotic symptoms and lack of insight, can affect patients' abilities to make fully informed decisions about their own care. Ensuring that consent for treatment is informed, voluntary, and competent can thus become a more difficult endeavor. The ethical principles underlying treatment of these patients, however, are the same as those guiding treatment of all patients. Informed consent, as an embodiment of these ethical principles, represents the expression of individual rights in both clinical and research contexts. Attention to the process of informed consent as an ongoing dialogue strengthens the clinician-patient relationship, improves adherence, and helps the patient clarify options, values, and preferences. In the research setting, psychiatric researchers are increasingly concerned with maximizing the abilities of individuals with severe mental illnesses such as schizophrenia to provide meaningful informed consent for protocols. This review addresses decision-making abilities of people with schizophrenia in both treatment and research contexts.