Bradley Adrian C, Baker Amanda, Lewin Terry J
Centre for Brain and Mental Health Research, University of Newcastle, University Drive, Callaghan, New South Wales, Australia.
Aust N Z J Psychiatry. 2007 Jun;41(6):501-8. doi: 10.1080/00048670701332300.
Outpatient group interventions have been shown to be efficacious in reducing substance use among people with psychosis. This is the first Australian study to report on the effectiveness of such interventions provided in a rural area by mental health and drug and alcohol clinicians, with follow up over 3 years. The primary aim was to investigate whether an open-ended weekly outpatient group intervention, consisting of motivational interviewing (MI) and cognitive behaviour therapy (CBT), was effective in reducing substance use and improving symptomatology and general functioning among people with psychosis.
This was a service evaluation project, with clinician-administered ratings made for four retrospective 3 monthly baseline observations and up to 12 3 monthly post-recruitment observations.
Thirty-nine participants entered the group intervention, with an average attendance of 28.51 sessions (SD=24.61). Compared to a baseline period of 1 year, the group intervention was associated with significant improvements in substance use, symptomatology, treatment non-compliance, overall functioning and unscheduled service use. A median split according to treatment group attendance indicated that there was no difference in improvement profiles on a factor reflecting overall severity among those who attended fewer (mean=10.63) versus more sessions (mean=45.50), but there was a sharper reduction in the use of acute mental health services among those who attended more sessions.
Significant change in functioning (including substance use and symptomatology) can occur within the context of a regular but relatively short outpatient group intervention, delivered in addition to usual treatment. However, extended group attendance over a 1 year period may be further associated with prevention of relapse and less unscheduled service use.
门诊小组干预已被证明在减少精神病患者的物质使用方面有效。这是澳大利亚第一项报告由心理健康及药物和酒精临床医生在农村地区提供此类干预措施并进行3年随访的有效性的研究。主要目的是调查一种开放式的每周门诊小组干预措施，包括动机性访谈（MI）和认知行为疗法（CBT），是否能有效减少精神病患者的物质使用，并改善其症状和总体功能。
这是一个服务评估项目，由临床医生对四个回顾性的每三个月一次的基线观察以及招募后多达12次每三个月一次的观察进行评分。
39名参与者进入小组干预，平均出席28.51节课程（标准差=24.61）。与1年的基线期相比，小组干预与物质使用、症状、治疗不依从、总体功能和非计划服务使用方面的显著改善相关。根据治疗组出席情况进行的中位数划分表明，出席课程较少（平均=10.63）与较多（平均=45.50）的参与者在反映总体严重程度的因素上的改善情况没有差异，但出席课程较多的参与者在急性心理健康服务使用方面的减少更为明显。
在常规但相对较短的门诊小组干预背景下，除常规治疗外，功能（包括物质使用和症状）可发生显著变化。然而，在1年期间延长小组出席时间可能进一步与预防复发和减少非计划服务使用相关。
