主动性社区治疗模式对易肇事肇祸严重精神障碍患者的应用效果

Application effect of assertive community treatment model in serious mental disorder patients with high risk of troublemaking behavior

目的:探讨主动性社区治疗模式(ACT)对易肇事肇祸严重精神障碍患者的应用效果。方法:将160例易肇事肇祸严重精神障碍患者随机分为研究组与对照组,每组80例。对照组接受社区规范管理治疗,研究组应用ACT干预,随访1年。入组时及随防1年末采用阳性和阴性症状评定量表(PANSS)、个人和社会功能量表(PSP)、精神疾病患者病耻感评估量表(SSPMI)、社会支持量表(SSRS)、家庭负担量表(FBS)对患者及其照料者进行效果评估。结果:随访1年后,研究组规律服药率、冲动暴力行为发生率及住院率为96.3%、3.8%、7.5%,对照组分别为87.5%、10.8%、13.8%,两组间差异有统计学意义(P均<0.05)。研究组PANSS总分及各因子分、SSPMI评分、FBS总分及经济负担、家庭日常活动、家庭关系、家庭心理健康因子分明显低于对照组,PSP、SSRS评分明显高于对照组(P均<0.05)。结论:ACT治疗能显著提高易肇事肇祸严重精神障碍患者的服药依从性,减少冲动暴力行为发生,改善患者病情和社会功能。

Objective:To explore the effect of assertive community treatment(ACT)model in serious mental disorder patients with high risk of troublemaking behavior.Method:160 serious mental disorder patients with high risk of troublemaking behavior were randomly divided into study group(n=80)and control group(n=80).The control group received community-based standardized management therapy,and the study group received ACT for 1 year.The Positive and Negative Syndrome Scale(PANSS),Personal and Social Performance Scale(PSP),Stigma Assessment Scale for People with Mental illness(SSPMI),Social Support Rating Scale(SSRS)and Family Burden Scale of Disease(FBS)were assessed at baseline and one year after follow up.Results:One year after follow-up,the incidence of regular medication-taking,troublemaking behaviors and hospitalization in the study group were 96.3%,3.8%and 7.5%,while in the control group those were 87.5%,10.8%and 13.8%,respectively.The differences between the two groups were statistically significant(all P<0.05).PANSS total score and scores of positive symptom,negative symptom,general psychopathological symptom,SSPMI score,FBS total score and financial burden,family daily activities,family relationship,family mental health factor score in the study group were lower than those in the control group,while PSP score and SSRS score were higher than those in the control group(all P<0.05).Conclusion:ACT can significantly improve the medication compliance in patients with severe mental illness,reduce the occurrence of troublemaking behaviors,and comprehensively improve patients'condition and social function.