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个案管理对严重精神障碍患者认知功能的影响 ——基于Zelen's设计随机对照研究
谭小林张代江蒋国庆陈红艳鲁陆程素满王一曲
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摘要:
目的 探索个案管理对严重精神障碍患者认知功能的影响。方法 于2017 年11 月至 2018年1月在重庆市招募选取严重精神障碍患者240例,采用单组同意Zelen's设计随机对照研究,将患者 分为常规随访对照组(n=115)和个案管理组(n=125),前者按照严重精神障碍患者管理服务规范要求开展 随访,后者进行多种认知功能康复活动。分别于干预前及干预后3个月、6个月、12个月采用修订版韦氏 成人智力量表分量表数字广度和数字符号分测验、语言流畅性测试、连线测验A进行评估。结果 重复 测量方差分析结果显示两组患者在数字广度顺背和倒背、数字符号、语言流畅性测试、连线测验A 完成 时间、错误次数评分上组间比较(F值分别为11.115、6.918、6.128、21.523、4.457、5.693,P< 0.01)、时间 主效应(F值分别为141.064、158.939、468.552、419.484、70.981、104.701,P< 0.01)、交互作用(F值分别 为167.652、168.388、384.422、235.782、53.549、19.324,P< 0.01)均有统计学意义。结论 个案管理可 以改善严重精神障碍患者的认知功能。
关键词:  精神障碍  认知功能  个案管理
DOI:10.3969/j.issn.1009-6574.2019.04.006
基金项目:重庆市卫生和计划生育委员会资助项目(2017MSXM122)
Impact of case management on the cognitive function of patients with severe mental disorders:a randomized controlled study based on Zelen's design
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Abstract:
Objectives To explore the impact of case management on the cognitive function of patients with severe mental disorders. Methods A total of 240 patients were recruited from Chongqing from November 2017 to January 2018. Patients were divided into a routine follow-up control group( n=115) and a case management group( n=125) using a single-group consent to Zelen's randomized controlled trial. The control group was followed up according to the requirements of the management criteria for severe mental disorders. The case management group went through a variety of cognitive rehabilitation activities. The revised Wechsler Adult Intelligence Scale subscales-Digital Width and Symbol Subscale, Language Fluency Test, Connection Test- Awere used to evaluate all the patients at the pre-intervention and 3 months, 6 months, and 12 months after the intervention time marks. Results The results of repeated measurement variance analysis showed that there were significant differences between the two groups in the scores of Digital Width and Symbol Subscale, Language Fluency Test, Completion Time and Error Number of Connection Test A( F=11.115,6.918,6.128,21.523,4.457, 5.693,P<0.01). The time main effect( F=141.064,158.939,468.552,419.484,70.981,104.701, P<0.01), and interaction( F=167.652,168.388,384.422,235.782,53.549,19.324, P < 0.01) were both statistically significant. Conclusions Case management can improve the cognitive function of patients with severe mental disorders.
Key words:  Mental disorder  Cognitive function  Case management

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