Verma S, Poon L Y, Lee H, Rao S, Chong S A
Department of Early Psychosis Intervention, Institute of Mental Health, 10 Buangkok View, Singapore.
East Asian Arch Psychiatry. 2012 Sep;22(3):114-7.
The alarmingly long duration of untreated psychosis in Singapore and probable severe consequences were the impetus for establishing the Early Psychosis Intervention Programme in 2001. In 2007, the Early Psychosis Intervention Programme became a part of the National Mental Health Blueprint. This study analysed the Early Psychosis Intervention Programme's key outcomes according to the case management model, and shows how the programme has evolved and expanded into indicated prevention by establishment of the Support for Wellness Achievement Programme focusing on at-risk mental state. The Early Psychosis Intervention Programme has incorporated an evaluation component into the clinical programme by administering regular structured assessments and generating operational statistics from the hospital's data systems. Based on data analysis from a study on consecutive patients accepted into the Early Psychosis Intervention Programme over a 4-year period, we found that at the end of 2 years of follow-up, majority of patients (85%) scored ≥ 61 on Global Assessment of Functioning (GAF) disability scale, while two-thirds (66%) met criteria for functional remission, which was defined as having a GAF disability score of ≥ 61 with engagement in age-appropriate vocation (gainfully employed or studying). There was also a significant decrease in the Positive and Negative Syndrome Scale for schizophrenia (t = 27.7, p < 0.05) and increase in GAF (t = 33.7, p < 0.05) mean scores from baseline at 2 years. As a national programme, the Early Psychosis Intervention Programme has articulated processes and outcome indicators to the stakeholders, and a periodic report card on these outcomes ensures accountability to the funders, patients, and their families.
新加坡未经治疗的精神病持续时间长得惊人，且可能产生严重后果，这成为了2001年设立早期精神病干预项目的动力。2007年，早期精神病干预项目成为国家心理健康蓝图的一部分。本研究根据病例管理模式分析了早期精神病干预项目的关键成果，并展示了该项目如何通过设立关注高危精神状态的健康成就支持项目，演变成并扩展为指示性预防。早期精神病干预项目通过定期进行结构化评估并从医院数据系统生成运营统计数据，将评估组件纳入了临床项目。基于对连续4年纳入早期精神病干预项目的患者进行的一项研究的数据分析，我们发现，在随访2年结束时，大多数患者（85%）在全球功能评估（GAF）残疾量表上的得分≥61，而三分之二（66%）的患者符合功能缓解标准，该标准定义为GAF残疾得分≥61且从事适合年龄的职业（有报酬工作或学习）。精神分裂症的阳性和阴性症状量表得分也从基线时显著下降（t = 27.7，p < 0.05），GAF得分在2年时从基线显著增加（t = 33.7，p < 0.05）。作为一个国家项目，早期精神病干预项目已向利益相关者阐明了流程和成果指标，并且关于这些成果的定期成绩单确保了对资助者、患者及其家属的问责。
