积极式个案管理对社区精神分裂症患者影响的1年随访  

Effect of assertive case management on quality of life in outpatients with schizophrenia: 1-year follow-up of a randomized controlled trail

作　　者：赵静 吕钦谕[1] 郭向晴 胡国芹[1] 汪作为[2] 姜雅琴[2] 陈健[3] 路聚保 伍毅[5] 谢红涛[6] 易正辉[1] 

机构地区：[1]上海交通大学医学院附属精神卫生中心,201108 [2]上海市虹口区精神卫生中心 [3]上海市黄浦区精神卫生中心 [4]上海市静安区精神卫生中心 [5]上海市杨浦区精神卫生中心 [6]上海市普陀区精神卫生中心

出　　处：《临床精神医学杂志》2014年第6期368-371,共4页Journal of Clinical Psychiatry

基　　金：国家自然科学基金(81171272);上海市公共卫生优秀学科带头人培养计划(GWDTR201227)

摘　　要：目的:评价积极式个案管理模式(ACM)对社区精神分裂症患者精神症状及生活质量的影响。方法:198例社区精神分裂症患者随机分为研究组(107例)接受ACM干预和对照组(91例)进行自然观察,随访12个月。采用阳性与阴性症状量表(PANSS)每3个月评估1次,生活质量量表(QOLS)在干预前、后进行评估。结果:经重复测量方差分析,干预后,PANSS阳性量表、阴性量表、一般精神病理量表的时间主效应(F=76.745,F=63.252,F=56.174;P均<0.01)、阳性量表分的组间主效应(F=4.650,P<0.05)以及阴性量表、一般精神病理量表的交互效应有统计学意义(F=20.236,F=9.635;P<0.01)。研究组干预后QOLS客观生活质量中日常生活、家庭生活评分较对照组上升明显(P<0.05或P<0.01);主观满意度中日常生活、家庭生活、法律与安全、社会关系、健康状况及总体满意度评分较对照组上升明显(P<0.05或P<0.01)。研究组PANSS阴性量表分及一般精神病理量表分差值与客观生活中日常生活差值、家庭生活差值呈正相关(r=0.394,r=0.40,r=0.312,r=0.211;P<0.05或P<0.001)。结论:ACM模式能更好地改善社区精神分裂症患者的阳性症状和生活质量。Objective：To evaluate the effect of assertive case management（ ACM）on quality of life and psychiatric symptoms in outpatients with schizophrenia. Method：One hundred and ninty-eight outpatients with schizophrenia were randomly divided into study group（n=107）receiving assertive ACM and control group （ n=91）receiving normal management treatment for 12 months. Psychiatric symptoms were assessed with posi-tive and negative syndrome scale（ PANSS）3 monthly.The quality of life were assessed with quality of life scale （QOLS）before and after intervention. Results：The repeated-measures analysis of variance indicated that time main effect（F=63.252,F=56.174;P〈0.01）and interaction effect（F=20.236,F=9.635;P〈0.01） were statistically significant in negative symptom factor score and the general pathology factor score of PANSS, and there were time main effect（F=76.745,P〈0.01）and group main effect（F=4.650,P〈0.05）in positive symptom factor score of PANSS.The scores of daily life factor,family life factor of objective of QOLS and the scores of daily life factor,family life factor,legal and safety factor,social relation factor,health condition factor, overall evaluation factor of subjective of QOLS were significantly increased in the study group than in the control group（ P〈0.05 or P〈0.01 ）.For the study group,the changes in scores of negative symptom factor and the general pathology factor of PANSS were positively correlated with the changes of daily life factor and family life factor of objective of QOLS（ r =0. 394,r =0. 40,r =0. 312,r =0. 211,P 〈0. 05 or P 〈0. 001 ）.

关 键 词：精神分裂症 积极式个案管理 生活质量 

分 类 号：R749.3[医药卫生—神经病学与精神病学]