Chatterjee Sudipto, Pillai Aravind, Jain Sumeet, Cohen Alex, Patel Vikram
Sangath Centre, Porvorim, Goa, India 403521.
Br J Psychiatry. 2009 Nov;195(5):433-9. doi: 10.1192/bjp.bp.108.057596.
There is little evidence of the feasibility, acceptability and impact of services for the care of people with psychotic disorders in low- and middle-income countries.
To describe the scaling up and impact of a community-based rehabilitation programme for people with psychotic disorders in a very-low-resource setting.
Longitudinal study of people with psychotic disorders who had been ill for an average of 8 years in a rural Indian community. All individuals received a community-based intervention package comprising psychotropic medications, psychoeducation, adherence management, psychosocial rehabilitation and support for livelihoods. The primary outcome was change in disability scores.
The cohort consisted of 256 people with psychotic disorders (schizophrenia, bipolar affective disorder and other psychosis) of whom 236 people completed the end-point assessments (92%), with a median follow-up of 46 months. There were significant reductions (P<0.05) in the levels of disability for the cohort, the vast majority (83.5%) of whom engaged with the programme. On multivariate analyses, lower baseline disability scores, family engagement with the programme, medication adherence and being a member of a self-help group were independent determinants of good outcomes. Lack of formal education, a diagnosis of schizophrenia and dropping out of the programme were independent determinants of poor outcomes.
Community-based rehabilitation is a feasible and acceptable intervention with a beneficial impact on disability for the majority of people with psychotic disorders in low-resource settings. The impact on disability is influenced by a combination of clinical, programme and social determinants.
在低收入和中等收入国家，几乎没有证据表明为精神障碍患者提供的护理服务具有可行性、可接受性和影响力。
描述在资源极度匮乏的环境中，针对精神障碍患者开展的社区康复项目的扩大规模及影响。
对印度农村社区中平均患病8年的精神障碍患者进行纵向研究。所有个体均接受了一套基于社区的干预措施，包括精神药物治疗、心理教育、依从性管理、心理社会康复和生计支持。主要结局是残疾评分的变化。
该队列由256名精神障碍患者（精神分裂症、双相情感障碍和其他精神病）组成，其中236人完成了终点评估（92%），中位随访时间为46个月。该队列的残疾水平有显著降低（P<0.05），其中绝大多数（83.5%）参与了该项目。在多变量分析中，较低的基线残疾评分、家庭成员对项目的参与、药物依从性以及成为自助小组的成员是良好结局的独立决定因素。未接受正规教育、精神分裂症诊断以及退出项目是不良结局的独立决定因素。
基于社区的康复是一种可行且可接受的干预措施，对资源匮乏环境中的大多数精神障碍患者的残疾状况具有有益影响。对残疾状况的影响受临床、项目和社会决定因素的综合影响。
