上海交通大学学报(医学版)

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老年期痴呆伴发精神行为障碍的家庭医疗干预模式

杨道良 1,李霞 2,苏宁 2,季卫东 1,陈玄玄 1   

  1. 1. 上海市长宁区精神卫生中心,上海交通大学 Bio-X中心附属绿地医院精神科,上海 200335;2. 上海交通大学 医学院附属精神卫生中心老年精神科,上海 200030
  • 出版日期:2017-03-28 发布日期:2017-03-30
  • 通讯作者: 陈玄玄,电子信箱:chenxx2000@126.com。
  • 作者简介:杨道良(1981—),男,主治医师,硕士;电子信箱:ydlbbmc@sina.com。
  • 基金资助:

    上海市长宁区卫生和计划生育委员会科研课题(20134Y06001)

Family medical intervention model of senile dementia with behavioral and psychological symptoms

YANG Dao-liang1, LI Xia2, SU Ning2, JI Wei-dong1, CHEN Xuan-xuan1   

  1. 1. Department of Psychiatry, Shanghai Changning District Mental Health Center, Green Land Hospital of Bio-X Center, Shanghai Jiao Tong University, Shanghai 200335, China; 2. Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
  • Online:2017-03-28 Published:2017-03-30
  • Supported by:

    Shanghai Changning District Health and Family Planning Commission Research Project,20134Y06001

摘要:

目的 ·探讨老年期痴呆伴发精神行为障碍的家庭医疗干预模式。方法 ·从上海市长宁区街道中整群抽取4个街道,按照入组标准选取研究对象,分为干预组(71例)和对照组(70例)。针对干预组提供精神科医师上门服务,给予药物治疗和心理社会干预。分别在基线时、6个月末、12个月末进行老年期痴呆患者病理行为量表(BEHAVE-AD)、简易精神状态评定量表(MMSE)、日常生活能力量表(ADL)、老年期痴呆生活质量量表(QOL-AD)、生活质量综合评定问卷(GQOLI-74)评分。结果 ·①对干预前2组患者的 BEHAVE-AD总分及各因子分进行比较,差异无统计学意义(P>0.05);重复测量方差分析显示,评定时间主效应显著(P<0.001),BEHAVE-AD总分、情感障碍和焦虑恐惧因子分组别主效应均存在显著差异(P<0.001),BEHAVE-AD总分、妄想和情感障碍因子分组别与时间交互作用均存在显著差异(P<0.05)。②BEHAVE-AD评分组间比较:在6个月末时,就幻觉、昼夜节律紊乱、情感障碍和焦虑恐惧因子分而言,干预组均明显优于对照组,差异有统计学意义(P<0.01);在12个月末时,就BEHAVE-AD总分及妄想、行为紊乱、情感障碍和焦虑恐惧因子分而言,干预组均优于对照组,差异有统计学意义(P<0.01)。③对干预前2组患者的MMSE、ADL、QOL-AD、GQOLI-74评分进行比较,差异无统计学意义(P>0.05);重复测量方差分析显示,评定时间主效应显著(P<0.001),MMSE和QOL-AD评分组别主效应均存在显著差异(P<0.001),MMSE、ADL、QOL-AD、GQOLI-74评分组别与时间交互作用均存在显著差异(P<0.05)。④MMSE、ADL、QOLAD、GQOLI-74评分组间比较:在6个月末时,干预组MMSE评分优于对照组,差异有统计学意义(P<0.05);在12个月末时,就MMSE、ADL、QOL-AD、GQOLI-74评分而言,干预组均优于对照组,差异有统计学意义(P<0.05)。结论 ·精神科医师上门服务并整合多学科团队成员的家庭医疗模式对改善老年期痴呆患者精神行为症状有效,可以提高患者和照料者的生活质量,持续开展效果更明显。

关键词: 老年期痴呆, 精神行为障碍, 家庭医疗模式

Abstract:

Objective · To explore family medical intervention model of senile dementia with behavioral and psychological symptoms. Methods · Four streets of Changning District in Shanghai were randomly selected and subjects were enrolled according to the inclusion criteria, who were randomly divided into the
intervention group (n=71) and control group (n=70). The intervention group received door-to-door service from psychiatric doctors, given drug treatment and
psychological intervention. Subjects were evaluated by several scales, including Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD),
Mini-Mental State of Examination (MMSE), Activity of Daily Living Scale (ADL), Quality of Life-Alzheimer's Disease (QOL-AD), and Generic Quality of Life
Inventory-74 (GQOLI-74), at baseline and by the end of 6 months and 12 months. Results · ① There was no significant difference in the total scores and all factor scores of BEHAVE-AD between the two groups before intervention (P>0.05). Repeated measures analysis of variance revealed a significant main effect of time (P<0.001). The between-group effect was significant in the total scores of BEHAVE-AD and the factor scores of affective disorder, anxiety and terror (P<0.001). The interactive effect of time×group was significant in the total scores of BEHAVE-AD and the factor scores of delusion and affective disorder (P<0.05). ② Intergroup comparison of the BEHAVE-AD scores indicated that by the end of 6 months, factor scores of hallucination, circadian rhythm disorder, affective disorder, anxiety and terror of the intervention group were remarkably better than those of the control group and the differences were statistically significant (P<0.01). By the end of 12 months, total scores of BEHAVE-AD, and factor scores of delusion, conduct disorder, affective disorder, anxiety and terror of the intervention group were remarkably better than those of the control group and the differences were statistically significant (P<0.01). ③ There was no significant difference in the scores of MMSE, ADL, QOL-AD and GQOLI-74 between the two groups before intervention (P>0.05). Repeated measures analysis of variance revealed a significant main effect of time (P<0.001). The between-group effect was significant in the scores of MMSE and QOL-AD (P<0.001). The interactive effect of time×group was significant in the scores of MMSE, ADL, QOL-AD, and GQOLI-74 (P<0.05). ④ Inter-group comparison of MMSE, ADL, QOL-AD, and GQOLI-74 scores indicated that by the end of 6 months, scores of MMSE of the intervention group were remarkably better than those of the control group and the differences were statistically significant (P<0.05). By the end of 12 months, scores of MMSE, ADL, QOL-AD, and GQOLI-74 of the intervention group were remarkably better than those of the control group and the differences were statistically significant (P<0.05). Conclusion · The family medical intervention model of door-to-door services from psychiatrists integrating multidisciplinary team is effective to attenuate the mental and behavioral symptoms of senile dementia patients, and can improve the quality of life of patients and caregivers. The effect of persistent implementation will be more remarkable.

Key words: senile dementia, behavioral and psychological symptoms, family medical intervention model