个案管理对伴有精神病性症状的抑郁症患者社会功能的影响

Influence of case management on social function of psychotic major depression patients

目的探讨个案管理对伴有精神病性症状的抑郁症患者社会功能的影响。方法选取2013年1月—2014年10月在上海市浦东新区南汇精神卫生中心接受治疗的伴有精神病性症状的抑郁症患者87例为研究对象,根据随机区组法将其分为研究组(43例)和对照组(44例)。研究组实施个案管理方案,对照组进行普通门诊随访方案。分别于入组时,治疗3、6、12个月后,采用汉密尔顿抑郁量表17项(HAMD-17)、简明精神病量表(BPRS)、家庭功能评定量表(FAD)、自知力与治疗态度问卷(ITAQ)进行评估比较。结果最终完成79例(研究组41例,对照组38例)。BPRS、HAMD评分组间比较、时间点比较及交互作用差异均有统计学意义(均P<0.05),两组治疗3、6、12个月BPRS、HAMD评分均较入组时降低,且治疗6、12个月低于治疗3个月,治疗12个月低于治疗6个月,差异均有统计学意义(均P<0.05)。研究组治疗3、6、12个月BPRS评分低于对照组,研究组治疗6、12个月HAMD评分低于对照组,差异均有统计学意义(均P<0.05)。FAD评分组间、时间点比较,差异均有统计学意义(均P<0.05),但交互作用差异无统计学意义(P>0.05)。两组治疗3、6、12个月FAD评分均较入组时降低,且治疗6、12个月低于治疗3个月,治疗12个月低于治疗6个月,差异均有统计学意义(均P<0.05)。研究组治疗6、12个月FAD评分低于对照组,差异均有统计学意义(均P<0.05)。ITAQ评分时间点比较及交互作用差异均有统计学意义(均P<0.05),组间比较差异无统计学意义(P>0.05)。两组治疗3、6、12个月ITAQ评分均较入组时升高,且治疗6、12个月高于治疗3个月,治疗12个月高于治疗6个月,差异均有统计学意义(均P<0.05)。两组ITAQ评分组间各时间点比较,差异无统计学意义(P>0.05)。研究组治疗12个月内服药依从性、复发及重新就业情况均明显优于对照组,差异有统计意义(均P<0.05)。结论个案管理与普通门诊随访比较,能提高患者服药依从性,进而有效缓解患者的抑郁症状、伴随的精神病性症状,改善社会功能,提高就业率。

Objective To explore the influence of case management on social function of psychotic major depression patients.Methods A total of 87 cases of depression psychotic major patients who were treated in Nanhui Mental Health Center,Pudong New Area,Shanghai from January 2013 to October 2014 were selected as the study subjects,and they were divided into study group(43 cases)and control group(44 cases)according to the random block group method.The study group implemented the case management program,and the control group carried out the general outpatient follow-up program.At the time of enrollment,three,six,and twelve months after treatment,Hamilton depression scale-17 items(HAMD-17),brief psychiatric rating scale(BPRS),and family assessment device(FAD)and insight and treatment attitude questionnaire(ITAQ)were used for evaluation and comparison.Results A total of 79 cases(41 in the study group and 38 in the control group)were finally completed.The differences in BPRS and HAMD scores among groups,time points and interaction were statistically significant(all P<0.05).BPRS and HAMD scores of the two groups at three,six and twelve months of treatment in the two groups were all lower than those at the time of enrollment,those at six and twelve months of treatment were less than three months of treatment,and those at twelve months of treatment were less than six months of treatment,and the differences were statistically significant(all P<0.05).The BPRS scores of the study group at three,six and twelve months of treatment were lower those of the control group,and the HAMD scores of the study group at six and twelve months of treatment were lower those of the control group,with statistically significant differences(all P<0.05).The differences in FAD scores among groups and time points were statistically significant(P<0.05),but the interaction difference was not statistically significant(P>0.05).The FAD scores of the two groups at three,six and twelve months of treatment in both groups were lower than those at enrollment,and those at six and twelve months of treatment were less than three months of treatment,and those at twelve months of treatment were less than six months of treatment,and the differences were statistically significant(all P<0.05).The FAD scores of the study group were lower than those of the control group at six and twelve months of treatment,and the differences were statistically significant(all P<0.05).There were statistically significant differences in ITAQ score at time point and interaction(all P<0.05),while there were no statistically significant differences between groups(P>0.05).ITAQ scores of the two groups at three,six and twelve months of treatment were all higher than those at the time of enrollment,and those at six and twelve months of treatment were higher than those at three months of treatment,and those at twelve months of treatment were higher than those at six months of treatment,with statistically significant differences(all P<0.05).There were no significant differences in ITAQ scores between the two groups at each time point(P>0.05).The study group was significantly better than the control group in terms of medication compliance,recurrence and re-employment within twelve months of treatment,with statistically significant differences(all P<0.05).Conclusion Compared with general outpatient follow-up,case management can improve patients'medication compliance,thus effectively relieve patients'depressive symptoms and accompanying psychiatric symptoms,improve social function,and increase employment rate.