CAJ | 학술논문

目的：探讨个案管理对社区精神分裂症患者的康复作用。方法：对在专科医院就诊的康复期精神分裂症患者（个案组，46例）实施18个月个体化康复方案（规范化治疗、康复训练、健康教育）；干预前、干预6、12、18个月分别进行阳性和阴性症状量表（PANSS）、康复状态量表（MRSS）、自知力与治疗态度问卷（ITAQ）和日常生活能力量表（ADL）评估，结果与在社区接受精神卫生服务的康复期精神分裂症患者（社区组，48例）比较。结果：两组 PANSS 总分和阴性症状分不同时间点差异有统计学意义，组别与时间有交互作用（P 均﹤0.01）；阳性症状分、一般病理分两组不同时间点差异有统计学意义（ P均﹤0.05）。MRSS 总分、活动能力缺乏、社交能力、目前症状与异常行为评分两组不同时间点差异有统计学意义（P 均﹤0.01）；MRSS 总分、依赖性、活动能力缺乏、社交能力分具有组别与时间交互作用（P ﹤0.05或 P ﹤0.01）。两组 ITAQ 中自知力与治疗态度评分具有交互作用（P 均﹤0.05）。两组 ADL 评分不同时间点差异有统计学意义，组别与时间有交互作用（P 均﹤0.01）。干预18个月时两组服药时间和依从性差异有统计学意义（P 均﹤0.05）。结论：个案管理对改善康复期精神分裂症患者的病情、自知力、治疗态度以及日常生活能力方面均优于常规社区精神卫生服务。
목적：탐토개안관리대사구정신분렬증환자적강복작용。방법：대재전과의원취진적강복기정신분렬증환자（개안조，46례）실시18개월개체화강복방안（규범화치료、강복훈련、건강교육）；간예전、간예6、12、18개월분별진행양성화음성증상량표（PANSS）、강복상태량표（MRSS）、자지력여치료태도문권（ITAQ）화일상생활능역량표（ADL）평고，결과여재사구접수정신위생복무적강복기정신분렬증환자（사구조，48례）비교。결과：량조 PANSS 총분화음성증상분불동시간점차이유통계학의의，조별여시간유교호작용（P 균﹤0.01）；양성증상분、일반병리분량조불동시간점차이유통계학의의（ P균﹤0.05）。MRSS 총분、활동능력결핍、사교능력、목전증상여이상행위평분량조불동시간점차이유통계학의의（P 균﹤0.01）；MRSS 총분、의뢰성、활동능력결핍、사교능력분구유조별여시간교호작용（P ﹤0.05혹 P ﹤0.01）。량조 ITAQ 중자지력여치료태도평분구유교호작용（P 균﹤0.05）。량조 ADL 평분불동시간점차이유통계학의의，조별여시간유교호작용（P 균﹤0.01）。간예18개월시량조복약시간화의종성차이유통계학의의（P 균﹤0.05）。결론：개안관리대개선강복기정신분렬증환자적병정、자지력、치료태도이급일상생활능력방면균우우상규사구정신위생복무。
Objective:To explore the effect of case management on rehabilitation in patients with schizo-phrenia. Method:Forty-six schizophrenic patients who treated in psychiatric hospital(case group)were trea-ted by individualized rehabilitation program(including standardized treatment,rehabilitation,health education) for 18 months. And all the patients were assessed by positive and negative symptoms scale(PANSS),Morning-side rehabilitation stats scale(MRSS),insight and treatment attitude questionnaire(ITAQ)and activities of daily life(ADL)before intervention and 6,12,18 months after intervention. The results were compared with those of 48 schizophrenic patients who received mantal health services in community(community group). Results:The total score of PANSS and negative symptoms score at different time points showed significant difference between the two groups;and had group × time interaction(all P ﹤0. 01);the differences of positive symptoms and general pathologic scores between the two groups at different time points had statistical significance(all P ﹤ 0. 05). The total score and scores of lack of symptoms,abnormal behavior,social ability of MRSS between two groups at differ-ent time points had significant difference(all P ﹤ 0. 01). There were group × time interaction in MRSS total score,and scores of dependency,lack of activity ability,social ability(P ﹤0. 05 or P ﹤0. 01). There were group × time interaction in self-knowledge and treatment attitude scores of ITAQ(all P ﹤0. 05). The ADL scores of the two groups had significant difference and group × time interaction(all P ﹤0. 01). Eighteen months after interven-tion,the time and adherence to medication between the two groups had significant differences(all P ﹤ 0. 05). Conclusion:Case management to improve,self-knowledge,attitudes,and daily life ability in schizophrenic pa-tients is superior to conventional community mental health services.