摘要
背景精神分裂症是一种常见的高复发、高致残的重性精神疾病,单一抗精神病药物治疗不仅有一定的药物不良反应,且改善患者生活及社会功能的效果甚微,故早期、综合、全程管理患者,对改善患者病情、提高患者生活及社会功能、早日回归社会有重要作用。目的探讨全病程管理模式在精神分裂症患者中的应用效果。方法选取石河子绿洲医院2019年1月至2020年2月收治的129例精神分裂症患者为研究对象,采用随机数字表法分为对照组(n=64)和研究组(n=65),收集患者基本资料,包括性别、年龄、婚姻状况、文化程度等。对照组患者入组后给予常规诊疗模式干预,研究组患者入组后在常规诊疗模式干预基础上接受全病程管理模式干预,所有患者入组后持续观察12个月。于干预前及入组3、6、12个月时分别对两组患者进行疗效、日常生活能力、社会功能及用药依从性评估(仅限已出院患者),出院后评估复发率。疗效评估:以阳性与阴性症状量表(PANSS)总分(阳性症状量表评分+阴性症状量表评分+一般精神病理症状量表评分)评估患者精神症状、以日常生活能力量表(ADL)评分评估患者日常生活能力、以复发率(仅限已出院患者)评估临床疗效;以社会功能缺陷筛选量表(SDSS)评分评估患者社会功能缺陷程度;以用药依从性量表(MMAS-8)评分评估患者用药依从性。结果干预前两组患者基本资料(性别、年龄、婚姻状况、文化程度等)及PANSS、ADL、SDSS、MMAS-8评分比较,差异均无统计学意义(P>0.05)。入组后研究组6、12个月的一般精神病理症状量表评分、PANSS总分、SDSS总分低于对照组(P<0.05);入组12个月的阴性症状量表评分、ADL总分低于对照组(P<0.05)。研究组中入组且出院后持续观察3、6、12个月时的患者用药依从性优于对照组(P<0.05)。两组在入组且出院后持续观察12个月时患者的复发率比较,差异无统计学意义(P>0.05)。结论全病程管理模式能有效减轻精神分裂症患者的精神症状,提高患者的日常生活能力、社会功能,同时提高其用药依从性。
Background Schizophrenia is a common mental disease with high rates of recurrence and disability.The therapeutic effects of antipsychotic drugs monotherapy are insufficient on improving patients'ability to daily life and social functioning,with possible adverse reactions.Therefore,early,comprehensive and whole course management is necessary for the improvement of patients'symptoms,ability to daily life and social functioning,to help them back to society as soon as possible.Objective To assess the efficacy of whole course management in patients with schizophrenia.Methods From January 2019 to Febuary 2020,one hundred and twenty-nine schizophrenia patients were recruited from Shihezi Oasis Hospital and divided into the study group(n=64)and control group(n=65).Demographic data including gender,age,marital status and education level of all patients were recorded by researchers.Patients in the control group received the standard therapy.While,patients in the study group received the whole course management base on the standard therapy,and both of them were followed up for one year.Treatment efficacy in the two groups was assessed by Positive and Negative Syndrome Scale(PANSS,including positive,negative syndrome and the general psychopathological symptom score,used to assess the patient's psychiatric symptoms),Social Functional Defect Screening Scale(SDSS,used to assess the degree of social functional defect),and Activity of Daily Living Scale(ADL,used to assess the patient's ability of daily living).And 8-item Morisky Medication Adherence Scale(MMAS-8,used to assess patient medication adherence)was used to assess medication compliance of discharged patients.And recurrence rates(used to evaluate clinical efficacy)were calculated in discharging patients only.All assessments were conducted before and 3,6,12 months after the study.Results There were no significant differences between two groups in demographic factors including gender、age、marital status and education level and PANSS,ADL,SDSS,MMAS-8 scores(P>0.05).Compared to the control group,there were lower scores of PANSS,SDSS and General Psychopathological Symptom Score at 6 and 12 month(P<0.05).And in study group there also showed significantly lower scores of negative symptoms and ADL at 12 month(P<0.05).Meanwhile,the post-intervention medication adherence was better in the study group(P<0.05).However,there was no significant difference between the two groups about the recurrence rate(P>0.05).Conclusion The whole course management could effectively alleviate the severity of schizophrenic,and could improve the ability to daily life,social functioning,as well as medication adherence in patients with schizophrenia.
作者
祖拉叶提·吐尔逊
张桂青
姚永坤
陆可可
ZULAYETI·Tuerxun;ZHANG Guiqing;YAO Yongkun;LU Keke(Shihezi University School of Medicine,Shihezi 832008,China;Department of Rehabilitation Psychiatry,First Affiliated Hospital,Shihezi University,School of Medicine,Shihezi 832008,China)
出处
《中国全科医学》
CAS
北大核心
2022年第5期595-602,共8页
Chinese General Practice
基金
兵团科技攻关计划项目(2018AB021)。
关键词
精神分裂症
全病程管理模式
疾病管理
疗效分析
服药依从性
治疗结果
Schizophrenia
The whole course management mode
Disease management
Efficacy analysis
Medication compliance
Treatment outcome
