J Psychiatr Pract. 2021 Nov 5;27(6):417-426. doi: 10.1097/PRA.0000000000000581.
The objective of this study was to understand the psychosocial and pharmacological approaches linked to better treatment adherence and outcomes (psychiatric hospitalizations, clinical severity, and suicide attempts) among patients with schizophrenia receiving the standard treatment in mental health units (MHUs) compared with patients in a community-based, case-managed program (CMP). An observational, prospective (10 y) study was conducted involving patients with severe schizophrenia (N=688). The treatment adherence of patients in the CMP was higher than among those in the MHUs (12.2% vs. 84.3% abandoning treatment; P<0.0001). Hospital admissions and suicide attempts were significantly lower among those treated in the CMP than among those receiving standard care in the MHUs (P<0.001). Scores on the clinical severity scale decreased significantly more in the group in the CMP than in the group in the MHUs (P<0.005). Treatment with long-acting injectable antipsychotic medication was closely linked with higher treatment retention (P<0.001) and fewer hospital admissions and suicide attempts compared with treatment with oral antipsychotics in both patient groups, with the effect greater in the group in the CMP (P<0.001). We highlight how patients with severe schizophrenia treated in a CMP with integrated treatment showed a higher retention rate, fewer psychiatric hospital admissions and suicide attempts, and less clinical severity compared with those receiving standard treatment in MHUs. Treatment with long-acting antipsychotics was also clearly related to these outcomes. A combination of intensive case-managed integrated treatment and treatment with long-acting antipsychotic medication facilitated the achievement of clinical and rehabilitation goals in patients with schizophrenia with severe symptoms and impairment compared with standard care and treatment with oral antipsychotics.
本研究旨在了解精神分裂症患者在接受精神卫生机构（MHU）标准治疗与接受基于社区、个案管理的方案（CMP）治疗时，与更好的治疗依从性和结局（精神科住院、临床严重程度和自杀企图）相关的心理社会和药理学方法。这是一项观察性、前瞻性（10 年）研究，涉及 688 名严重精神分裂症患者。CMP 组的患者治疗依从性高于 MHU 组（12.2%放弃治疗，84.3%；P<0.0001）。与 MHU 组接受标准护理的患者相比，CMP 组的住院和自杀企图明显减少（P<0.001）。CMP 组的临床严重程度评分明显下降，MHU 组下降幅度更大（P<0.005）。与 MHUs 中的口服抗精神病药物治疗相比，长效注射用抗精神病药物治疗与更高的治疗保留率（P<0.001）以及更少的住院和自杀企图密切相关，而在 CMP 组中效果更大（P<0.001）。我们强调了在 CMP 中接受综合治疗的严重精神分裂症患者与在 MHU 中接受标准治疗的患者相比，具有更高的保留率、更少的精神病住院和自杀企图，以及更少的临床严重程度。长效抗精神病药物治疗也与这些结果密切相关。强化的个案管理综合治疗与长效抗精神病药物治疗的结合，促进了严重症状和功能障碍的精神分裂症患者实现临床和康复目标，优于标准护理和口服抗精神病药物治疗。
