Effects of Psychiatric Rehabilitation on the Number of Relapse, Number of Admission, Days of Hospitalization, and Direct Treatment Costs of Schizophrenic Patients: Two-Year Follow-up Study / 신경정신의학

ABSTRACT

OBJECTIVE: We evaluated the clinical efficacy of a comprehensive psychiatric rebabiliation of schizophrenia, including family psychoeducation,patient education,socail skills tranining,group psychotherapy,art therapy,and ocupational therapy. METHOD: From September 1993 to february 1995,173 chronic schizophrenics who met DSM-lV criteria and were discharged from a locked ward were assigned into the psychiatric rehabilitation service group(psychiatric rehabilitation group,n=46) or the customary out patient service group(out-patient group,n=127)prospectively,but not randomly. Assignment was based on preferences of patients and their relatives. Each subject included in the psychiatric rehabilitation group received twice weekly patient education,social skills training, family psychoeducation, group psychotherapy, art therapy, occupational therapy and maintenance chemotherapy during a 6-month period. Those in the out-patient group received individual supportive psychotherapy and maintenance chemotherapy according to their clinical needs for 10-20 minutes once per week. After entry into the study,all subjects were assessed for the number of readmission,days of hospitalization,and the direct treatment costs through the first and second year of follow-ups. These outcome variables were also compared pre-and post-2 years at the time point of entry into the study. Aftercare chemotherapy on a weekly to monthly basis continued for the remailder of the two year follow-up period. RESULTS: With regard to the mean number of hospital admissions per vear,the mean days of hospitalization per year, and the direct treatment costs per year, psychiatric rehabilitation broup had significantly decreased all clinical outcomes 2 years after compared with before receiving psychiatric rehabilitation. But there were no significant differences in the all clinical outcomes between between before and after study intake in the out-patient group. For the number of relapse regardless of drug compliance, 4 patients(9%) during first year and 14 patients(30%) during second year were relapsed in the 46 subjects of the psychiatric rehabiliation group. In contrast, 75 patients(59%) during first year and 90 patients(71%) during second year relapsed in the out-patient group. When considering the effect of drug noncompliance to relapse,4(9%) and 14 patients(30%) were relapsed while on medication respectively during the first and second year in the 46 of the psychiatric rehabilitation group, vs. 27(34%) of 79 patients on medication during the first year and 31(46%) of 68 patients on medication during the second year were relapsed in the out-patient group. CONCLUSIONS: These results indicate that the comprehensive psychiatric rehabiliation can be useful therapeutic intervention both to improve the clinical outcomes of schizophrenic patients and to reduce the economical burden of their relatives.