An Evaluation of Modified Intensive Care Management(M-ICM)&IPS(Individual Placement and Support) for Psychiatric Patients Readmitted within 3 months of Discharge

本研究旨在发展改良重症监护管理(M-ICM，ICM与基于社区的护理管理相同)和IPS护理模式，并对出院三个月内再次入院的精神病患者的护理模式进行评估。本研究是与九州一家精神科医院合作进行的，该医院为70名精神分裂症患者提供M-ICM(CBCM)和IPS，从他们再次入院到出院6个月。患者的精神症状和自我护理管理都一直不稳定。所有患者要么在上次出院后三个月内再次入院，要么继续住院超过三个月。分别在再次入院、出院、出院后三个月和六个月进行评估。评估的基础是对精神症状、日常生活技能、社会功能、家庭对患者是负担的看法、生活质量和WOR…进行评级的指数将患者分为两组：35例(A组)接受M-ICM+IPS治疗，35例(B组)仅接受M-ICM治疗。两组患者多与家人生活在一起，父母在家庭支持方面起主要作用。两组患者在简明精神病评定量表(BPRS)、生活技能量表(LSP)、生活质量和工作效率方面有显著差异。在入院时、出院时、出院后3个月和6个月时，患者的BPR、GAF、LSP、Fas和工作效率均有显著改善。家庭对患者是负担的感觉也有显著改善，尤其是在出院时和出院后3个月。通过这一点，很明显，这种干预是必要的，不仅是为了控制症状，而且是为了帮助患者基于对个性、心理发展问题和对日常生活的渴望的理解与社区建立联系。A组患者的工作效率高于B组。但A组中的许多患者在精神病院工作，而不是在公司。这项研究使我们认识到，优化利用社区可用的所有社会资源-包括为残疾和困难患者提供的资源，而不一定是为精神疾病患者量身定做的资源-促进患者出院后在社区的稳定定居。这些结果是从承认M-ICM(CBCM)和IPS的重要性、寻找和利用社区资源的必要性的角度讨论的。从“以人为本”向“以地为本”过渡支持的重要性，以扩大患者的支持基础。较少

The purpose of this study was to develop Modified Intensive Care Management(M-ICM,ICM is the same as Community Based Care Management)&IPS care model and to evaluate this care model for psychiatric patients who readmitted psychiatric patients within three month of discharge. This study was conducted with the cooperation of a psychiatric hospital in Kyushu at which M-ICM(CBCM)&IPS were provided to 70 schizophrenic patients from the time of their readmission to six months after discharge.The patients had been unstable both in their psychiatric symptoms and in self-care management. All were either readmitted within three months of their previous discharge or their hospitalization continued more than three months.Evaluations were made upon of readmission, discharge, three months and six months after discharge. Evaluations were based on indexes rating psychiatric symptoms, daily living skills, social functioning, family perceptions of the patient being a burden, Quality of Life (QOL) and wor … More k-rate.The patients were divided into two groups: 35 patients (Group A) were provided M-ICM&IPS and 35 patients (Group B) were provided only M-ICM. Many of the patients of both groups lived with their families, with parents playing the major role in terms of family support.Significant difference were recognized between two groups regarding the Brief Psychiatric Rating Scale (BPRS), the Life Skills Profile (LSP), QOL and work-rate. Furthermore Significant improvements were recognized regarding BPRS, GAF, LSP, FAS and work-rate at the times of admission, discharge, three month and six month after the discharge.Family perceptions of the patient being a burden also improved significantly, especially at times of discharge and three months after discharge in Group A. Group A received support interventions for both patients and their families. Through this it became clear that such interventions were needed, not just for control of symptoms, but for helping patients connect with the community based on an understanding of personality, psychological developmental issues, and desires concerning daily life. Furthermore patients in A-Group had high work-rate compared with that of B-Group. But many patients in A-Group was working at working house for psychiatric patients, not in the company.This study led us to the realization that optimum utilization of all the social resources available to the community-including resources for those with disabilities and difficulties and not necessarily tailored for patients with psychiatric disorders-promotes a patient's stable settlement in the community after discharge from the hospital.These results were discussed from a viewpoint acknowledging the significance of M-ICM(CBCM)&IPS, the necessity of finding and utilizing community resources, and the importance of transitional support from "Person-oriented" to "Place-oriented" so as to widen the patient's support base. Less