个案管理与小组工作对出院精神分裂症患者的康复效果比较

Comparison between case management and group work on rehabilitation effects in discharged schizophrenia patients

【目的】探讨个案管理和小组工作2种干预方法对出院精神分裂症患者康复的效果。【方法】选择上海市某区精神卫生中心出院后稳定期精神分裂症患者100例,随机分为个案组和团体组各50例,分别采用个案管理和小组工作方法定期进行精神症状评估、服药指导、功能训练、健康宣教等服务,为期6个月,在干预前后对2组患者进行阳性和阴性症状量表(PANSS)及社会功能缺陷筛选量表(SDSS)评估。【结果】干预后,个案组患者的阳性症状评分、阴性症状评分和PANSS总分均较干预前有所降低,差异均有统计学意义(t=4.214、3.926、3.929,P<0.001);团体组患者干预前后的PANSS量表评分仅一般病理和总评分的差异有统计学意义(t=2.195、2.466,P<0.05)。2组干预前后SDSS评分的差异均有统计学意义(P<0.001)。减分率比较显示,2组阳性症状评分的减分率差异有统计学意义(z=-2.937,P<0.05),SDSS评分的减分率差异有统计学意义(z=-3.834,P<0.001)。【结论】个案管理和小组工作方法均能稳定精神分裂症患者的病情和改善其社会功能,但2种方法在效果的侧重点上略有差异。

[Objective]To compare the intervention effect of Case Management and Group Work in discharged schizophrenic patients.[Methods]A total of 100 patients with stable schizophrenia who were discharged from a mental health center in a district of Shanghai were randomly divided into two groups:case management(CM)and group work(GW),with 50 patients each.The group work method and case management model were used,respectively,to provide psychiatric symptom assessment,medication guidance,functional training,health education and other services to for 6 months.Both Positive and Negative Syndrome Scale(PANSS)and Social Disability Screening Schedule(SDSS)were used for assessment at the beginning and at the end of 6th month.The conditions and the improvement of social function of these two groups were compared.[Results]Before and after the intervention,the positive symptom score,negative symptom score and PANSS total score of the CM group were decreased,the difference was statistically significant(t=4.214,3.926,3.929,P<0.001).The PANSS score of the GW group only had significant difference before and after the general pathology and the total score(t=2.195,2.466,P<0.05).There were significant differences in SDSS scores between these two groups before and after the intervention(P<0.001).There was a significant difference in the reduction rate of positive symptom score between the two groups(z=-2.937,P<0.05).There was also a significant difference in the reduction rate of SDSS scores(z=-3.834,P<0.001).[Conclusion]Both case management and group work can stabilize the condition of schizophrenia patients and improve social function,but there is a slight difference in the emphasis of the two methods.