社区个案管理对精神分裂症患者疗效的1年随访:一项单盲随机对照研究

Single-blind, Randomized Controlled Trial of Effectiveness of Community-based Case Management for Individuals with Schizophrenia over a 12-month Follow-up Period

目的:探讨社区个案管理对精神分裂症患者精神症状、攻击行为及社会功能的影响。方法:以随机数字表法将符合ICD-10精神分裂症诊断标准的120名患者分为个案管理组(个案组)和对照组,实施12个月的干预随访。采用单盲法以阳性和阴性症状量表(Positive And Negative Syndrome Scale,PANSS)、修改版外显攻击行为量表(Modified Overt Aggression Scale,MOAS)和社会功能缺陷量表(Social Disability Screening Schedule,SDSS)评估患者基线及干预后3、6、9、12月末的心理指标。结果:个案组干预前后不同时间PANSS因子分和总分、MOAS总分及SDSS总分比较,差异有统计学意义(P<0.001);对照组干预前后不同时间PANSS因子分和总分及SDSS总分比较,差异有统计学意义(P<0.05)。不同时间点两组比较,除基线(PANSS分量表分和总分、MOAS总分及SDSS总分)和3月末(PANSS分量表分和总分及SDSS总分)两组得分差异无统计学意义(P>0.05)外,其余各时间点个案组得分均低于对照组,差异有统计学意义(P<0.05)。结论:与常规社区精神卫生服务相比,个案管理可显著改善精神分裂症患者的精神症状、攻击行为及社会功能。

Objective: To assess the effect of a community-based case management on psychotic symptoms, aggressive behaviors and social function of individuals with schizophrenia. Methods: A total of 120 individuals who met ICD-10 diagnostic criteria for schizophrenia discharged from hospital were recruited and divided into case management group and control group by the method of random number table for a 12-month follow-up, and the Positive And Negative symptoms Scale(PANSS), Modified Overt Aggression Scale(MOAS) and Social Disability Screening Schedule(SDSS) were used to evaluate their psychotic symptoms, aggression and social function by single blind method at baseline and 3, 6, 9, 12 months after intervention. Results: There were significant differences in PANSS sub-scale scores and total score, MOAS total score and SDSS total score at different time in the case management group before and after intervention(P<0.001), while there were significant differences in PANSS sub-scale scores and total score and SDSS total score in the control group(P<0.05). Except for the baseline(PANSS sub-scale scores and total score, MOAS total score and SDSS total score) and the end of 3 month(PANSS sub-scale scores and total score and SDSS total score), there were significant differences between the two groups at different time points(P<0.05), and all scores above in case management group were significantly lower than those in control group(P<0.05). Conclusion: Compared with conventional community mental health services, communitybased case management might significantly improve the psychotic symptoms, aggressive behaviors, and social function of individuals with schizophrenia over the one-year follow-up period.