Craig Tom K J, Johnson Sonia, McCrone Paul, Afuwape Sarah, Hughes Elizabeth, Gournay Kevin, White Ian, Wanigaratne Shamil, Leese Morven, Thornicroft Graham
Health Service and Population Research Department, Kings College London, London, United Kingdom.
Psychiatr Serv. 2008 Mar;59(3):276-82. doi: 10.1176/ps.2008.59.3.276.
Persons with severe mental illness have high rates of comorbid substance use disorders. These co-occurring disorders present a significant challenge to community mental health services, and few clinical trials are available to guide the development of effective services for this population. The study aimed to evaluate the effectiveness of a program for case managers that trained them to manage substance use disorders among persons with severe mental illness.
A cluster-randomized controlled trial design was used in South London to allocate case managers either to training or to a waiting list control condition. Outcomes and service costs (health care and criminal justice) over 18 months of 127 patients treated by 40 case managers who received training were compared with those of 105 patients treated by 39 case managers in the control condition.
Brief Psychiatric Rating Scale scores for the intervention group indicated significant improvements in psychotic and general psychopathology symptoms. Participants in the intervention group also reported fewer needs for care at follow-up. No significant differences were found between the two groups in levels of substance use at 18 months. At follow-up both groups reported increased satisfaction with care. Service costs were also similar for the two groups.
Compared with standard care, integrated treatment for co-occurring disorders provided by nonspecialist mental health staff produced significant improvements in symptoms and level of met needs, but not in substance use or quality of life, at no additional cost.
重度精神疾病患者共患物质使用障碍的比例很高。这些共病障碍给社区心理健康服务带来了重大挑战，而且几乎没有临床试验可用于指导针对这一人群开发有效的服务。该研究旨在评估一项针对个案管理员的项目的有效性，该项目培训他们管理重度精神疾病患者的物质使用障碍。
在伦敦南部采用整群随机对照试验设计，将个案管理员分配到培训组或等待名单对照组。将接受培训的40名个案管理员治疗的127名患者在18个月内的结果和服务成本（医疗保健和刑事司法方面）与对照组中39名个案管理员治疗的105名患者的结果和服务成本进行比较。
干预组的简明精神病评定量表得分表明，精神病性和一般精神病理学症状有显著改善。干预组的参与者在随访时报告的护理需求也较少。两组在18个月时的物质使用水平没有显著差异。在随访时，两组都报告对护理的满意度有所提高。两组的服务成本也相似。
与标准护理相比，由非专科心理健康工作人员提供的共病障碍综合治疗在不增加成本的情况下，在症状和满足需求水平方面有显著改善，但在物质使用或生活质量方面没有改善。
