Florentin Sharon, Rosca Paola, Bdolah-Abram Tali, Neumark Yehuda
The Hebrew University Hadassah Medical School, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Department for the Treatment of Substance Abuse, Ministry of Health and The Hebrew University of Jerusalem, Jerusalem, Israel.
Front Psychiatry. 2021 Feb 5;12:621259. doi: 10.3389/fpsyt.2021.621259. eCollection 2021.
Co-occurrence of chronic psychotic disorders and substance use disorder (SUD) is clinically challenging and increasingly prevalent. In 2000, legislation was passed in Israel to foster rehabilitation and integration in the community of persons with mental health disorders. In 2010, the need to allocate resources for patients with these co-occurring disorders (COD) was officially recognized. Yet, most rehabilitation services were not specifically designed for COD. This study examines the relationship between duration of community rehabilitation and number of psychiatric hospitalization days among persons with/without COD in Israel. Data from the National Psychiatric Case Register on 18,684 adults with schizophrenia/schizoaffective disorders hospitalized in 1963-2016, was merged with data from the Israel Mental Rehabilitation Register. Associations and interactions between COD-status (COD/non-COD), time-period (Period: 2001-2009, Period: 2010-2016), duration of housing or vocational rehabilitation on hospitalization days per year were analyzed using repeated-measures ANOVA. The proportion of non-COD chronic psychotic patients who received rehabilitation services increased from 56% in Period to 63% in Period, as it did among COD patients-from 30 to 35%. The proportion of non-COD patients who received longer-duration vocational rehabilitation (≥1 year) was significantly higher (43%) than among COD patients (28%) in both time periods. For housing rehabilitation, these proportions were 79 and 68%, respectively. Persons with COD experienced more hospitalization days annually than non-COD patients. Duration of rehabilitation (less/more than a year) was inversely associated with annual number of hospitalization days ( < 0.0001). This pattern was noted in both COD and non-COD groups and remained significant after controlling for age, sex, COD group, percent of hospitalizations with SUD, and age at first hospitalization. COD patients with prolonged rehabilitation seemingly achieve long-term clinical improvement similar to non-COD patients, despite most rehabilitation settings in Israel not being designed for COD patients. Yet, COD patients receive overall less rehabilitation services and for shorter periods than non-COD patients. Long-term rehabilitation services should be provided to COD patients, who may need more time to commit to treatment. To achieve better long-term mental health improvements, a continued expansion of community-based integrative treatment and rehabilitation services for COD patients is needed in Israel.
慢性精神障碍与物质使用障碍（SUD）并存的情况在临床上具有挑战性且日益普遍。2000年，以色列通过了一项立法，以促进精神健康障碍患者在社区中的康复与融入。2010年，为这些并存障碍（COD）患者分配资源的必要性得到了正式认可。然而，大多数康复服务并非专门为COD患者设计。本研究考察了以色列有/无COD的人群中社区康复时长与精神科住院天数之间的关系。将1963 - 2016年期间住院的18684名患有精神分裂症/分裂情感性障碍的成年患者的国家精神病例登记数据与以色列精神康复登记数据进行了合并。使用重复测量方差分析来分析COD状态（COD/非COD）、时间段（时间段：2001 - 2009年，时间段：2010 - 2016年）、住房或职业康复时长与每年住院天数之间的关联和交互作用。接受康复服务的非COD慢性精神障碍患者比例从第一时间段的56%增加到第二时间段的63%，COD患者也是如此——从30%增加到35%。在两个时间段中，接受较长时长职业康复（≥1年）的非COD患者比例（43%）显著高于COD患者（28%）。对于住房康复，这些比例分别为79%和68%。与非COD患者相比，COD患者每年的住院天数更多。康复时长（少于/多于一年）与每年住院天数呈负相关（<0.0001）。在COD组和非COD组中均观察到这种模式，并且在控制了年龄、性别、COD组、伴有SUD的住院百分比以及首次住院年龄后，这种模式仍然显著。尽管以色列的大多数康复机构并非为COD患者设计，但接受长期康复的COD患者似乎能实现与非COD患者相似的长期临床改善。然而，COD患者总体上接受的康复服务比非COD患者少，且康复时间更短。应该为COD患者提供长期康复服务，他们可能需要更多时间来坚持治疗。为了在长期精神健康方面取得更好的改善，以色列需要持续扩大针对COD患者的社区综合治疗和康复服务。
