Fernández-Miranda Juan J, Díaz-Fernández Silvia, López-Muñoz Francisco
Asturian Mental Health Service Área V.-H.U. Cabueñes, Servicio de Salud del Pº de Asturias (SESPA), 33211 Gijón, Spain.
Asturian Institute on Health Research (ISPA), 33011 Oviedo, Spain.
J Pers Med. 2022 Jul 4;12(7):1101. doi: 10.3390/jpm12071101.
Case management is a model of personalized intervention in people with severe mental illness. To explore the treatment adherence and effectiveness of patients with severe schizophrenia (Clinical Global Impression Severity, CGI-S ≥ 5) undergoing treatment in a community-based, case-managed program (CMP) with an integrated pharmacological and psychosocial approach compared with the standard treatment, an observational, ten-year follow-up study was conducted on patients treated in mental health units (MHUs) or a CMP (n = 688). Treatment discontinuation, hospitalizations, suicide attempts, and antipsychotic (AP) medications were recorded. Clinical severity was assessed with the CGI-S. Adherence to the CMP was higher than adherence to standard treatment (p < 0.001). There were fewer hospitalizations and suicide attempts in the CMP (p < 0.001). The clinical severity decreased more in the CMP (p < 0.005). Long-acting injectable (LAI) antipsychotic medication was more closely related to these outcomes than oral antipsychotics (APs) were (p < 0.001). Patients with severe schizophrenia in an integrated CMP recorded higher treatment compliance and better outcomes compared with standard care. Treatment with LAI APs was linked to these outcomes. A personalized combination of case management and LAI AP medication was more effective in these patients than standard treatment and oral APs.
病例管理是一种针对重症精神疾病患者的个性化干预模式。为了探究与标准治疗相比，在一个采用药物治疗与心理社会干预相结合的社区病例管理项目（CMP）中接受治疗的重度精神分裂症患者（临床总体印象严重程度，CGI-S≥5）的治疗依从性和疗效，对在精神卫生单位（MHUs）或CMP接受治疗的患者（n = 688）进行了一项为期十年的观察性随访研究。记录治疗中断情况、住院次数、自杀未遂情况以及抗精神病药物（AP）的使用情况。采用CGI-S评估临床严重程度。CMP的依从性高于标准治疗（p < 0.001）。CMP中的住院次数和自杀未遂情况较少（p < 0.001）。CMP中临床严重程度的下降更为明显（p < 0.005）。长效注射（LAI）抗精神病药物与这些结果的相关性比口服抗精神病药物（APs）更强（p < 0.001）。与标准治疗相比，综合CMP中的重度精神分裂症患者记录到更高的治疗依从性和更好的疗效。LAI APs治疗与这些结果相关。在这些患者中，病例管理与LAI AP药物的个性化组合比标准治疗和口服APs更有效。
