Randomized trial of a population-based care program for people with bipolar disorder
Randomized trial of a population-based care program for people with bipolar disorder
复制标题
DOI：
10.1017/s0033291704002624
复制
发表时间：
2005-01-01
影响因子：
6.9
通讯作者：
Rutter, C
中科院分区：
文献类型：
--
作者：
Simon, GE;Ludman, EJ;Rutter, C
背景。尽管有有效的药物和心理治疗，但在日常实践中对双相情感障碍的护理往往不足。本试验评估了以人群为基础的双相情感障碍患者样本中多组分护理管理方案的有效性。在前一年接受双相情感障碍治疗的441名患者被随机分配到继续常规护理或常规护理加系统护理管理计划，包括：初始评估和护理计划，每月电话监测，包括简短的症状评估和药物监测，与心理健康治疗团队的反馈和协调，以及结构化的团体心理教育计划-所有这些都由护士护理经理提供。采用纵向间隔随访评估法对抑郁和躁狂症状的严重程度进行逐周的盲法季度评估。被分配到干预组的参与者在12个月的随访期间平均躁狂评分明显较低（Z = 2）。44, p = 0（.）015)，轻躁狂或躁狂发作的时间减少约三分之一(2)。第59周。1()。69周)。在整个随访期间，两组的平均抑郁评分没有显著差异，但干预组的抑郁评分随时间的推移下降幅度更大（组间相互作用的Z统计量= 1）。98, p = 0(.)048)。双相情感障碍的系统护理方案在12个月内显著降低躁狂的风险。初步结果表明，随着时间的推移，它对抑郁症的影响越来越大，但需要更长的随访时间。
Background. Despite the availability of efficacious medications and psychotherapies, care of bipolar disorder in everyday practice is often deficient. This trial evaluated the effectiveness of a multi-component care management program in a population-based sample of people with bipolar disorder.Method. Four hundred and forty-one patients treated for bipolar disorder during the prior year were randomly assigned to continued usual care or usual care plus a systematic care management program including: initial assessment and care planning, monthly telephone monitoring including brief symptom assessment and medication monitoring, feedback to and coordination with the mental health treatment team, and a structured group psychoeducational program - all provided by a nurse care manager. Blinded quarterly assessments generated week-by-week ratings of severity of depression and mania symptoms using the Longitudinal Interval Follow-Up Evaluation.Results. Participants assigned to the intervention group had significantly lower mean mania ratings averaged across the 12-month follow-up period (Z = 2(.)44, p = 0(.)015) and approximately one-third less time in hypomanic or manic episode (2(.)59 weeks nu. 1(.)69 weeks). Mean depression ratings across the entire follow-up period did not differ significantly between the two groups, but the intervention group showed a greater decline in depression ratings over time (Z statistic for group-by-time interaction = 1(.)98, p = 0(.)048).Conclusions. A systematic care program for bipolar disorder significantly reduces risk of mania over 12 months. Preliminary results suggest a growing effect on depression over time, but longer follow-up will be needed.