社区综合干预模式对精神分裂症患者康复效果的影响研究

摘要

目的 探讨社区综合干预模式对精神分裂症患者康复效果的影响.方法 选取2005年1月—2016年1月新乡市国家严重精神障碍信息系统中的精神分裂症在管患者150例,并随机分为家庭护理教育组、社交技能康复训练组、综合干预组3组,每组50例.所有患者均根据病情接受相应的常规药物治疗.在此基础上家庭护理教育组患者及其家属接受精神分裂症相关内容的知识培训;社交技能康复训练组患者及其家属接受社交技能康复训练;综合干预组患者接受家庭护理教育组和社交技能康复训练组中所有干预措施,持续干预3个月.干预前、干预后6个月和12个月时,分别采用阳性和阴性症状量表(PANSS)、康复状态量表(MRSS)、社会功能缺陷筛选量表(SDSS)评估患者的精神症状严重程度、康复状况及社会功能.结果 干预期间患者死亡2例、失访1例、中途退出2例,最终纳入的患者分别为家庭护理教育组49例、社交技能康复训练组48例、综合干预组48例,共计145例.3组PANSS、MRSS、SDSS得分比较,差异有统计学意义(P<0.05);不同时间点比较,差异有统计学意义(P<0.05);组别和时间在PANSS、MRSS、SDSS得分上存在交互作用(P<0.05).其中,干预后6个月和12个月时,综合干预组和家庭护理教育组、社交技能康复训练组PANSS 、MRSS、SDSS得分比较,差异有统计学意义(P<0.05);家庭护理教育组和社交技能康复训练组PANSS 、MRSS、SDSS得分比较,差异有统计学意义(P<0.05).3组干预后1年内精神分裂症复发率比较,差异有统计学意义(P<0.05).结论 社区综合干预模式能有效降低精神分裂症患者精神症状严重程度,改善康复状况和社会功能,并降低干预后1年内精神分裂症复发率.%Objective To explore the effects of community-based comprehensive interventions on the rehabilitation of schizophrenia patients. Methods Based on the inclusion and exclusion criteria, from Xinxiang National Register Information System for Severe Mental Disorders, we enrolled 150 schizophrenic patients under management from January 2005 to January 2016 and equally randomized them into home-based care and education group, social skills rehabilitation training group and comprehensive intervention group. In addition to the conventional medical treatment, patients in home-based care and education group, social skills rehabilitation training group, comprehensive intervention group and their family members were given schizophrenic knowledge training, rehabilitation training about social skills, schizophrenic knowledge training combined with rehabilitation training about social skills, respectively. The interventions for all groups lasted for 3 months. The mental symptoms, rehabilitation status and social functioning were assessed by Positive and Negative Symptoms Scale (PANSS),Morningside Rehabilitation Status Scale (MRSS) and Social Disability Screening Schedule (SDSS) before intervention and at 6,12 months after intervention, respectively. Results The final participants were 145 cases (49 in home-based care and education group, 48 in social skills rehabilitation training group and 48 in comprehensive intervention group) after excluding 2 deaths during intervention, 1 case lost to follow-up and 2 withdrawals. The average scores of PANSS, MRSS and SDSS measured before intervention, and at 6, 12 months after intervention differed significantly between the groups (P<0.05). Contents and duration of intervention produced interaction effects on the scores of PANSS, MRSS, and SDSS in all groups (P<0.05). At both 6, 12 months after intervention, compared with other two groups, comprehensive intervention group demonstrated significantly different average scores of PANSS, MRSS and SDSS (P<0.05); home-based care and education group and social skills rehabilitation training group had obviously different average scores of PANSS, MRSS and SDSS (P<0.05). The recurrence rate of schizophrenia within 1 year after intervention differed significantly among the three groups (P<0.05). Conclusion Community-based comprehensive interventions can effectively alleviate the schizophrenia symptoms, improve the rehabilitation status and social functioning, as well as reduce the recurrence rate within 1 year after intervention in schizophrenic patients.