全病程病案管理模式对首诊强迫症患者24周疗效随访研究  

Whole course case management in a 24 weeks follow-up study for first-coming obsessive-compulsive disorder patients

作　　者：王虓[1] 王振[1] 江开达[1] 仇剑崟[2] 苏晖[1] 张海音[1] 

机构地区：[1]上海市精神卫生中心,200030 [2]上海交通大学医学院精神病学教研室

出　　处：《上海精神医学》2007年第3期129-132,共4页Shanghai Archives of Psychiatry

基　　金：WHO首发精神疾病患者的全病程管理合作项目(编号:K-001-05)

摘　　要：目的比较全病程病案管理模式和门诊治疗模式干预首诊强迫症急性期和巩固期的疗效。方法前瞻性平行对照研究。在符合ICD-10强迫症诊断标准的100例患者中,随机分配48例接受全病程病案管理,另52例仅接受门诊治疗,对所有病例跟踪随访24周。在治疗前基线、第2周、第4周、第8周、第24周随访评定病情严重程度。结果(1)全病程管理组48例随访24周没有病例脱落;对照组52例,随访24周脱落14例(26.92%)。(2)全病程管理组治疗第8周和第24周的Yale-Brown强迫症量表(Y-Brown)总分和汉密顿抑郁量表(HAMD17)、汉密顿焦虑量表(HAMA)总分的均值显著低于对照组(P<0.05)。(3)全病程管理组第8周和第24周疗效显著高于对照组(P<0.01)。全病程管理组第24周的显效率显著高于对照组(P<0.01)。(4)急性期随访全病程管理组治疗终止治疗率显著低于对照组(P<0.05)。结论全病程管理模式干预首诊强迫症急性期和巩固期的疗效和依从性优于单纯门诊治疗模式。Objective： To determine the effectiveness of whole course case management for first-coming obsessive-compulsive disorder （OCD） patients. Methods： It was an ongoing randomized controlled trial. Totally 100 first - coming outpatients who met ICD - 10 criteria for OCD were admitted to this study. 48 patients were randomized to whole course case management group with normal treatment, and 52 patients to normal treatment group only. Patients were assessed by Yale - Brown obsessive compulsive scale （ YBOCS）, Hamilton Depression scale （HAMD17 -item） and Hamiton anxiety scale （HAMA） at baseline, week 2, week 4, week 8, and week 24 separately. Results： （ 1 ） At the end of follow - up, no patient was lost in case management intervention group while 14 patients （26.92%） were lost in controlled group. （2） Patients had a lower YBOCS, HAMD17, HAMA total score than did controlled group patients at week 8 and week 24 respectively（P 〈0.05 ）. （3） The treatment effect of the intervention group was significantly higher compared with the controlled group at week 8 and week 24 （ P 〈 0.01 ）. The number of patients with obvious treatment progress on YBOCS at week 24 was significantly different between two groups （ P 〈 0. 01 ）. The number of patients with no treatment change on YBOCS in 8 weeks and 24 weeks was significantly different from two groups （ P 〈 0.01 ）. （4） At the acute phase the rate of treatment termination of whole course case management group was significantly lower than that of the controlled group （ P 〈 0.05 ）. Conclusion： Whole course case management intervention seems to significantly improve the first - coming OCD treatment outcomes and compliance at acute and strengthened stage.

关 键 词：首诊强迫症 病案管理 随访研究 

分 类 号：R749.7[医药卫生—神经病学与精神病学]