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纳入门诊精神病治疗团队的重症精神病患者的临床及社会变化:一项18个月的随访研究。

Clinical and social changes in severely mentally ill individuals admitted to an outpatient psychosis team: an 18-month follow-up study.

作者信息

Bengtsson-Tops Anita, Hansson Lars

机构信息

Department of Health Sciences, Kristianland University, Sweden.

出版信息

Scand J Caring Sci. 2003 Mar;17(1):3-11. doi: 10.1046/j.1471-6712.2003.00108.x.

Abstract

AIM

The study investigated clinical and social changes during an 18-month follow-up period in a group (n = 76) of schizophrenic outpatients admitted to a newly implemented outpatient psychosis team. Changes related to level of contact with the psychosis team were also examined as well as aspects of the content of the treatment interventions and work situation from a staff perspective.

METHODS

Structured face-to-face interviews with the patients were performed at baseline and after 18 months. The Camberwell Assessment of Need instrument, the Lancashire Quality of Life Profile and the Interview Schedule for Social Interaction were used on both interview occasions along with Global Assessment of Functioning Scale and Brief Psychiatric Rating Scale. Thematic open-ended questions were used in staff interviews.

RESULTS

Psychiatric symptoms, number of needs and number of met needs decreased, and perceived quality of life improved for the total sample during the follow-up period. Patients only in contact with a psychiatrist in the psychosis team improved more in symptoms and spent fewer days in hospital during follow-up time compared with those who had combined psychiatric and supportive contacts, and were also more satisfied with their medication. Patients with a combined contact deteriorated in psychosocial functioning compared with the group only in contact with a psychiatrist. Some of the elements in treatment interventions and work situation as well as hindrances in providing community-based care adapted to the patients' needs were identified.

CONCLUSIONS

Community-based psychiatric services, to a larger extent, need to embrace evidence-based interventions and to perform regular, structured and comprehensive need assessments in order to ensure the effectiveness of interventions. Attention should be paid to staff motivation and education as well as to providing practical guidelines, supervision and support.

摘要

目的

本研究调查了一组(n = 76)新成立的门诊精神病团队收治的精神分裂症门诊患者在18个月随访期内的临床和社会变化。还研究了与与精神病团队接触程度相关的变化,以及从工作人员角度看治疗干预内容和工作情况的各个方面。

方法

在基线时和18个月后对患者进行结构化面对面访谈。在两次访谈中均使用了坎伯韦尔需求评估工具、兰开夏郡生活质量概况和社会互动访谈时间表,同时还使用了功能总体评估量表和简明精神病评定量表。在工作人员访谈中使用了开放式主题问题。

结果

随访期间,总样本的精神症状、需求数量和满足的需求数量减少,生活质量感知得到改善。与那些同时有精神科和支持性接触的患者相比,在精神病团队中仅与精神科医生接触的患者在随访期间症状改善更多,住院天数更少,并且对药物治疗也更满意。与仅与精神科医生接触的组相比,有综合接触的患者在心理社会功能方面有所恶化。确定了治疗干预和工作情况中的一些要素以及在提供适应患者需求的社区护理方面的障碍。

结论

基于社区的精神科服务在很大程度上需要采用循证干预措施,并定期进行结构化和全面的需求评估,以确保干预措施的有效性。应关注工作人员的积极性和教育,以及提供实用指南、监督和支持。

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