个案管理模式在广泛性焦虑障碍患者中的应用

Application of case management in patients with generalized anxiety disorder

目的探讨个案管理模式对广泛性焦虑障碍患者生活质量及临床结局的影响。方法选取来自四川省精神卫生中心心身疾病科且符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)广泛性焦虑障碍(GAD)诊断标准的120例住院患者,随机分为个案管理组和对照组各60例,两组均采用原有抗焦虑药物和日常心理治疗,个案管理组还进行个案管理干预。于干预前、干预后1、2、4、8、12、24、48周采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、临床疗效总评量表(CGI)和幸福指数量表(Index of Well-being)进行评定。结果两组服药依从性、复发率、满意度比较差异均有统计学意义(P均<0.05);治疗后两组HAMA、HAMD、CGI评分均较基线期低,差异有统计学意义(P<0.01);在治疗及随访期间,个案管理组HAMA、HAMD、CGI及总体幸福感评分均较对照组低,差异有统计学意义(P均<0.05)。结论对GAD在药物治疗及一般心理支持治疗基础上实施个案管理服务48周后患者的焦虑、抑郁症状缓解更明显,服药依从性更好,复发率更低、生活质量更好,患者对治疗的满意度提高。

Objective To investigate the case management model of the quality of life in patients with Generalized Anxiety Disorder( GAD) and the influence of clinical outcome. Methods 120 hospitalized GAD patients which from the Mental Health Center of Sichuan Province and met the diagnose of CCMD- 3 were divided into the case management group and the control group. Two groups adopted original anti- anxiety drugs and routine therapy,the case management group also received case management. Before 1,2,4,8,12,24 and 48 weeks of the intervention,Hamilton Anxiety Scale( HAMA),Hamilton Depression Scale( HAMD),Clinical Global Impression( CGI) and Index of Well- being were assessed. Results Two groups taking compliance,recurrence rate,satisfaction comparison difference was statistical significant( P < 0. 05). Two groups of HAMA and HAMD,CGI scores after treatment were lower than the baseline period,the difference was statistically significant( P < 0. 01). During the period of treatment and follow- up,case management group of HAMA and HAMD,CGI and general well- being score were lower than those of control group,the difference was statistically significant( P < 0. 05). Conclusion For GAD in drug treatment and general psychological support therapy on the basis of the implementation of case management service after 48 weeks of anxiety and depression symptoms in patients with more obvious,medication adherence is better,lower recurrence rate and better quality of life,satisfaction of patients to treatment.