全科团队康复服务对社区精神分裂症患者的影响
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摘要
【目的】研究全科团队参与的康复服务对社区精神分裂症患者的症状、疾病家庭负担及病耻感的影响。【方法】将上海市某区12个街镇120名社区慢性稳定期精神分裂症患者按照街道为单位方便分组:干预组60人与对照组60人(对照组脱落1人),干预组每周接受由全科团队提供的主动式康复服务2次,共12周,对照组仅接受社区随访和一般康复指导治疗,在干预前及第4、8、12周对两组患者及家属采用阳性和阴性症状量表(PANSS)、疾病家庭负担量表(FBS)、病耻感量表等进行评估,结果用SPSS 13.0统计软件进行分析。【结果】干预前各项量表差异均无统计学意义。通过两两比较第8周末、12周干预组的PANSS总分、阳性因子分、一般精神病理分均较对照组显著下降(P<0.05或P<0.01),第12周干预组PANSS阴性因子分较照组显著下降(P<0.01);干预前后患者病耻感量表总分具交互效应(P<0.01);第8周家庭娱乐以及家庭总负担低于对照组(P<0.05)。【结论】全科团队参与的社区康复服务提供更全面和多层次服务,可以改善精神分裂症患者的精神症状、减少患者病耻感、增强病人的日常生活能力,减轻疾病家庭负担。
[Objective] To study the effect of rehabilitation service participated in by the GP team for schizophrenic patients in communities. [Methods] A total of 120 chronic stable schizophrenic patients selected from 12 streets and towns in a community of Shanghai were divided into two groups(60 in each): intervention and control.The intervention group received active rehabilitation service from GP team twice a week,for a total of 12 weeks and the control group only community follow-up and general rehabilitation guidance treatment.The patients and their family members were evaluated with the Positive and Negative Syndrome Scale(PANSS),Family Burden Scale of Disease(FBS),Scale of Stigma in People with Mental Illness(SSPMI) before and at 4,8,12 weeks after intervention. [Results] Before intervention,there was not statistical difference found in each scale of the two groups.Through pairwise comparison,at the end of the 8 week and at 12 weeks,PANSS total score,positive factor score and general psychopathology score all remarkably dropped as compared with those of the control group(P<0.05 or P<0.01); at 12 weeks,in the intervention group,PANSS negative factor score remarkably dropped as compared with those of the control group(P<0.01).Before and after intervention,patients′ stigma scores had interacted effect(P<0.01);at 8 weeks,home entertainment and total family burden were lower than those of the control group(P<0.01). [Conclusion] Community rehabilitation service participated in by GP team not only improves part of the psychiatric symptoms of chronic schizophrenic patients,but also reduces their feeling of stigma,and relieves their family burden.
[Objective] To study the effect of rehabilitation service participated in by the GP team for schizophrenic patients in communities. [Methods] A total of 120 chronic stable schizophrenic patients selected from 12 streets and towns in a community of Shanghai were divided into two groups(60 in each): intervention and control.The intervention group received active rehabilitation service from GP team twice a week,for a total of 12 weeks and the control group only community follow-up and general rehabilitation guidance treatment.The patients and their family members were evaluated with the Positive and Negative Syndrome Scale(PANSS),Family Burden Scale of Disease(FBS),Scale of Stigma in People with Mental Illness(SSPMI) before and at 4,8,12 weeks after intervention. [Results] Before intervention,there was not statistical difference found in each scale of the two groups.Through pairwise comparison,at the end of the 8 week and at 12 weeks,PANSS total score,positive factor score and general psychopathology score all remarkably dropped as compared with those of the control group(P<0.05 or P<0.01); at 12 weeks,in the intervention group,PANSS negative factor score remarkably dropped as compared with those of the control group(P<0.01).Before and after intervention,patients′ stigma scores had interacted effect(P<0.01);at 8 weeks,home entertainment and total family burden were lower than those of the control group(P<0.01). [Conclusion] Community rehabilitation service participated in by GP team not only improves part of the psychiatric symptoms of chronic schizophrenic patients,but also reduces their feeling of stigma,and relieves their family burden.
引文
[1]傅伟忠,张明,秦虹云,等.社区综合康复模式对慢性精神分裂症患者疗效评估[J].上海预防医学,2013,25(3):113-116.
[2]赵雪雪,孙晨,刘艳丽,等.我国精神分裂症患者社区康复服务方式的研究[J].社区卫生管理,2016,30(5):160-162.
[3]世界卫生组织.国际疾病分类第10版(ICD-10)第5卷“精神与行为障碍”[M].北京:人民卫生出版社.1997.
[4]安孝群,陈圣祺,肖艳红,等.系列康复治疗对住院慢性精神分裂症患者个人和社会功能疗效[J].临床精神医学杂志,2015,25(2):89-92.
[5]朱慧莉,安孝群,胡满基,等.系统康复治疗对慢性精神分裂症住院患者的疗效分析[J].当代护士,2015(10):93-95.
[6]司天梅,杨建中,舒良,等.阳性和阴性症状量表(PANSS,中文版) 的信、效度研究[J].中国心理卫生杂志,2004,18(1):45-47.
[7]曾庆枝,何燕玲,田泓,等.精神病患者病耻感评估量表的初步编制[J].中国心理卫生杂志,2009,23(9):634-637,642.
[8]俞玮,沈燕敏,顾丽娟.住院精神分裂症患者照顾者疾病负担调查及护理对策[J].中国民康医学,2012,24(11):1338-1339,1341.
[9]徐妹,张国芳,占归来,等.社区康复期精神分裂症患者社会支持与自我效能研究[J].中国康复,2015,30(1):71-73.
[10]王彦凤,蔡军.精神障碍患者社区康复服务[J].上海医药,2014,35(22):3-6.
[11]陈发展,刘亮,秦虹云,等.系统思维和人文精神在德国精神医学中的应用——中国年轻医护人员的学习考察见闻与心得[J].医学与哲学,2017,38(9B):94-96.
[12]宋修珍,孔临萍,燕炯,等.国外社区精神医学的发展及现状[J].卫生软科学,2004,18(3):134-136.
[13]李平,张斌.社会歧视对门诊精神分裂症患者服药依从性的影响[J].川北医学院学报,2016,31(4):542-544,552.
[14]LEE S,CHIU M Y L,TSANG A,et al.Stigmatizing experience and structural discrimination associated with the treatment of schizophrenia in Hong Kong[J].Soc Sci Med,2006,62(7):1685-1696.
[2]赵雪雪,孙晨,刘艳丽,等.我国精神分裂症患者社区康复服务方式的研究[J].社区卫生管理,2016,30(5):160-162.
[3]世界卫生组织.国际疾病分类第10版(ICD-10)第5卷“精神与行为障碍”[M].北京:人民卫生出版社.1997.
[4]安孝群,陈圣祺,肖艳红,等.系列康复治疗对住院慢性精神分裂症患者个人和社会功能疗效[J].临床精神医学杂志,2015,25(2):89-92.
[5]朱慧莉,安孝群,胡满基,等.系统康复治疗对慢性精神分裂症住院患者的疗效分析[J].当代护士,2015(10):93-95.
[6]司天梅,杨建中,舒良,等.阳性和阴性症状量表(PANSS,中文版) 的信、效度研究[J].中国心理卫生杂志,2004,18(1):45-47.
[7]曾庆枝,何燕玲,田泓,等.精神病患者病耻感评估量表的初步编制[J].中国心理卫生杂志,2009,23(9):634-637,642.
[8]俞玮,沈燕敏,顾丽娟.住院精神分裂症患者照顾者疾病负担调查及护理对策[J].中国民康医学,2012,24(11):1338-1339,1341.
[9]徐妹,张国芳,占归来,等.社区康复期精神分裂症患者社会支持与自我效能研究[J].中国康复,2015,30(1):71-73.
[10]王彦凤,蔡军.精神障碍患者社区康复服务[J].上海医药,2014,35(22):3-6.
[11]陈发展,刘亮,秦虹云,等.系统思维和人文精神在德国精神医学中的应用——中国年轻医护人员的学习考察见闻与心得[J].医学与哲学,2017,38(9B):94-96.
[12]宋修珍,孔临萍,燕炯,等.国外社区精神医学的发展及现状[J].卫生软科学,2004,18(3):134-136.
[13]李平,张斌.社会歧视对门诊精神分裂症患者服药依从性的影响[J].川北医学院学报,2016,31(4):542-544,552.
[14]LEE S,CHIU M Y L,TSANG A,et al.Stigmatizing experience and structural discrimination associated with the treatment of schizophrenia in Hong Kong[J].Soc Sci Med,2006,62(7):1685-1696.