积极式个案管理模式对精神分裂症患者生活质量影响的研究

Comparative study of Assertive Case Management on quality of life in schizophrenia

目的探讨积极式个案管理模式对精神分裂症患者生活质量的影响。方法选取800例精神分裂症患者随机分为两组，分别接受积极式个案管理治疗（研究组，入组400例，完成380侧）和普通康复治疗（对照组，入组400例，完成350例），应用阳性与阴性症状量表（PANSS）、Camberwell需求评价量表（CAN）、生活质量量表（QOLS）、家庭负担量表（FBI）和WHO-精神残疾评价量表简化版（DAS—S）分别于入组前、入组后1年、2年末对患者的精神症状、生活质量变化等进行评定。结果（1）治疗后，PANSS总分和阴性症状评分，两组比较差异有统计学意义（P〈0．05）；（2）CAN帮助栏目分量表中基本生活、家庭和社会职能及社会救助因子分研究组较前均有下降，两组比较差异有统计学意义（P〈0．05），cAN帮助来源分量表中社会帮助因子分研究组较前升高，两组比较差异有统计学意义（P〈0．01）；（3）生活质量量表中日常生活、家庭生活及安全感因子分，研究组均有提高，对照组无变化，两组比较差异有统计学意义（P〈0．05）；（4）家庭负担量表评分，家庭经济和心理健康因子分，研究组明显下降，对照组无变化，两组比较差异有统计学意义（P〈0．05）；（5）精神残疾评价量表评分，研究组DAS—S评分有下降，两组比较差异有统计学意义（P〈0．05）。结论积极式个案管理模式能提高精神分裂症患者社会功能及生活质量。

Objective To investigate the efficacy of Assertive Case Management （ACM） on quali- ty of life of schizophrenic patients. Methods 800 patients with schizophrenia were randomly divided into the study group which were treated with Assertive Case Management and the control group with normal management treatment for 24 months. Clinical efficacy and social function were assessed with Positive and Negative Symptoms Scale and Camberwell Assessment of Need, Quality of Life Scale, Family Bur- den Instructing, WHO/Disability assessment schedule--starter edition at the baseline, 12th month,24th month. Results There was statistical significant difference in the total score and the negative factor score of PANSS between two groups in 12th month, 24th month （P 〈 0. 05）. It is still different from the con- trol group in the score of some items of Camberwell Assessment of Need on the 12th month and the base- line. ACM had obviously improved quality of life. There was statistical significant difference in the score of two item of FBI between the 12th month and the baseline through the ACM. The score of DAS--S in the study group had also decreased significantly （P 〈 0. 05）. Conclusions Assertive Case Management can improve the quality of life and social function in schizophrenia.