Ashcroft Katie, Kim Edward, Elefant Erica, Benson Carmela, Carter John A
Dr. Katie Ashcroft, LTD, Lancashire, England, UK.
Janssen Scientific Affairs, LLC, Titusville, NJ, USA.
Community Ment Health J. 2018 Oct;54(7):983-991. doi: 10.1007/s10597-018-0289-x. Epub 2018 Jun 9.
With the recent movement toward a personal-recovery paradigm to treat schizophrenia, the locus of mental health care delivery has shifted toward community-based care. Family caregivers comprise a substantial component of that community, and are often providing care for longer periods, but often have no formal training or support. Caregiver-directed psychosocial interventions (CDPI) have been developed to train and assist caregivers in their efforts to maximize the odds of treatment success for those in their care. This meta-analysis compared CDPI versus treatment as usual (TAU) on outcomes such as hospitalization, relapse, non-compliance, and "other outcomes" (emergency services utilization, suicide attempt, and death). A systematic literature search (2005-2015) was conducted to identify randomized controlled trials of outpatient administered CDPI versus TAU to treat adult patients recovering from schizophrenia. Relative risks (RR) with 95% confidence intervals derived via random effects meta-analysis were calculated to compare CDPI versus TAU on the aforementioned outcomes. Eighteen of the 693 citations were retained for analysis. Overall RR for CDPI versus TAU suggested improved outcomes associated with CDPI: hospitalization [0.62 (0.46, 0.84) p < 0.00001], relapse [0.58 (0.47, 0.73) p < 0.00001] and other outcomes [0.70 (0.19, 2.57) p = 0.59]. CDPI was associated with significantly better compliance with medication and clinical activities combined [0.38 (0.19, 0.74) p = 0.005]. Medication compliance alone favored CDPI but was non-significant. Compliance with clinical activities alone favored CDPI significantly [0.22 (0.11, 0.47) p < 0.00001]. CDPI is associated with reductions in hospitalization, relapse, and treatment non-compliance.
随着近期向个人康复模式治疗精神分裂症的转变，精神卫生保健的提供场所已转向社区护理。家庭照顾者是该社区的重要组成部分，他们通常提供更长时间的护理，但往往没有接受过正规培训或获得支持。已开发出照顾者指导的心理社会干预措施（CDPI），以培训和协助照顾者，使他们所照顾的患者治疗成功的几率最大化。这项荟萃分析比较了CDPI与常规治疗（TAU）在住院、复发、不依从以及“其他结果”（急诊服务利用、自杀未遂和死亡）等方面的差异。进行了一项系统的文献检索（2005 - 2015年），以确定门诊给予CDPI与TAU治疗成年精神分裂症康复患者的随机对照试验。通过随机效应荟萃分析得出95%置信区间的相对风险（RR），以比较CDPI与TAU在上述结果方面的差异。693条引文中有18条被保留用于分析。CDPI与TAU的总体RR表明，CDPI与改善的结果相关：住院率[0.62（0.46，0.84）p < 0.00001]、复发率[0.58（0.47，0.73）p < 0.00001]和其他结果[0.70（0.19，2.57）p = 0.59]。CDPI与药物和临床活动的总体依从性显著提高相关[0.38（0.19，0.74）p = 0.005]。仅药物依从性有利于CDPI，但不显著。仅临床活动依从性显著有利于CDPI[0.22（0.11，0.47）p < 0.00001]。CDPI与住院、复发和治疗不依从的减少相关。
