Division of Comprehensive Welfare, Tohoku Fukushi University, Sendai, Japan.
Psychiatry Clin Neurosci. 2012 Aug;66(5):383-9. doi: 10.1111/j.1440-1819.2012.02348.x.
The beneficial effects of assertive community treatment (ACT), which has been widely acclaimed as being successful in several foreign countries, must also be objectively evaluated with respect to the transition from inpatient to community-based mental health treatment in Japan. This was the first study that examined effects of the ACT program in Japan using pre/post design data of the pilot trial of the ACT program in Japan project.
The study included 41 subjects hospitalized at Kohnodai Hospital, National Center of Neurology and Psychiatry between May 2003 and April 2004 for severe mental illness and who met inclusion criteria for entry regarding age, diagnosis, residence, utilization of mental health services, social adjustment, and ability to function in daily activities. All subjects provided informed consent for study participation and were followed for 1 year after hospital discharge.
Comparison of the number of days and frequency of inpatient psychiatric hospitalization and frequency of emergency psychiatric visits between the 1-year period before hospitalization and 1-year period after hospital discharge showed a significant decrease in number of days and frequency of hospitalization. Comparison at 1 year after discharge with baseline showed no change in satisfaction with overall quality of life or Brief Psychiatric Rating Scale scores, but the Global Assessment of Functioning score significantly increased, and the antipsychotic dose (chlorpromazine equivalent) significantly decreased.
Despite some limitations in methodology and conclusions, this study suggests that ACT enables persons with severe mental illness to live for longer periods in the community, without worsening of symptoms, decreased social function, or deterioration in quality of life.
被广泛称赞为在多个国外国家取得成功的坚定社区治疗（ACT），必须在日本从住院治疗向基于社区的精神卫生治疗过渡的背景下，对其进行客观的评估。这是第一项使用日本坚定社区治疗项目试点试验的预/后设计数据，来评估日本 ACT 项目效果的研究。
该研究纳入了 2003 年 5 月至 2004 年 4 月期间在国立神经病学与精神病学研究中心 Kohnodai 医院住院的 41 名患有严重精神疾病且符合年龄、诊断、居住、精神卫生服务利用、社会适应和日常活动能力纳入标准的患者。所有患者均签署了参与研究的知情同意书，并在出院后随访 1 年。
与住院前 1 年相比，住院后 1 年的住院天数和住院频率、急诊就诊频率的比较显示住院天数和住院频率显著减少。与基线相比，出院后 1 年的总体生活质量满意度或简明精神病评定量表评分无变化，但总体功能评估量表评分显著增加，抗精神病药物剂量（氯丙嗪当量）显著减少。
尽管在方法学和结论方面存在一些局限性，但本研究表明，ACT 可使患有严重精神疾病的患者在社区中更长时间地生活，而不会导致症状恶化、社会功能下降或生活质量恶化。
