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Oviranosti in potrebe po rehabilitaciji ambulantnih bolnikov s shizofrenijo
Avtor: Matjaž Groznik
Mentor: doc.dr. Milan Licina, dr.med.; as.dr. Rok Tavcar, dr.med
Izhodišca: Shizofrenija je kronicna duševna motnja, ki moti bolnikovo vsakdanje življenje in delo ter ovira bolnika pri stikih z okolico. Velika vecina bolnikov se zdravi bolnišnicno le krajši cas, nato pa zdravljenje nadaljujejo ambulantno. Leta 1996 je slovenska raziskava o kakovosti življenja med ambulantnimi bolniki s shizofrenijo ugotovila, da je ocena kakovosti življenja povezana s stopnjo ucinkovitosti in samostojnosti. Namen raziskave je bil ugotoviti psihopatološko simptomatiko, oviranosti in potrebe bolnikov s shizofrenijo, ki se zdravijo ambulantno. Osnovna domneva je bila, da demografski, socialni in bolezenski dejavniki vplivajo na ucinkovitost in samostojnost ambulantnih bolnikov s shizofrenijo, njihove oviranosti in potrebe po rehabilitaciji. Dodatna domneva je, da obstajajo med spoloma statisticno znacilne razlike v socialnih, demografskih in bolezenskih znacilnostih.
Metode: V presecno (cross-sectional) raziskavo sem vkljucil 50 bolnikov s shizofrenijo (5% vzorec populacije, 31 moških in 19 žensk), ki prejemajo vzdrževalno nevrolepticno terapijo v obliki depoja na Centru za izvenbolnišnicno psihiatrijo. Z vsakim bolnikom sem opravil pogovor. Za zbiranje socialnih, demografskih in bolezenskih podatkov sem uporabil naslednje standardizirane ocenjevalne lestvice: Krawiecka Scale, Quality of Life, Global Assessment Scale, Camberwell Assessment of Need Scale. Dodal sem vprašanja o nekaterih demografskih, socialnih in bolezenskih podatkih in o terapiji, ki so jo prejemali. Razliko med spoloma sem ugotavljal s t-testom in hi-kvadrat testom.
Rezultati: Povprecna starost bolnikov je bila 43 let. Bolniki so se šolali v povprecju 11 let. Ženske so imele daljšo delovno dobo kot moški (p<0,01). Približno dve tretjini bolnikov sta bili invalidsko upokojeni. Vecina bolnikov je živela s starši, medtem ko so imele bolnice vec stikov s svojimi partnerji kot s starši. Moški so zboleli v povprecju štiri leta prej kot ženske, vendar razlika ni bila statisticno znacilna (p>0,05). Bolezen je pri bolnikih in bolnicah v povprecju trajala približno 14 let. Kar polovica bolnikov je imela pridružene telesne bolezni. Alkohol je zlorabljala petina bolnikov, desetina je bila od alkohola odvisnih. Stopnja ucinkovitosti in samostojnosti, merjena z GAS, je bila 60 tock. Moški so imeli v povprecju nižje ocene kot ženske (57 oz. 66 tock, p<0,01). Pri ženskah so bili izraženi nekateri blažji simptomi, ki so zmerno zmanjšali ucinkovitost in samostojnost. Moški so bili manj ucinkoviti in samostojni ter so imeli bolj izražene simptome. Povprecne ocene posameznih podrocij v vprašalniku o kakovosti življenja so bile med 2 in 4, kar kaže na to, da so bili bolniki zmerno ovirani na podrocju medosebnih stikov, pri zaposlitvi in na duševnem podrocju. Ženski spol, širša socialna mreža in daljša delovna doba so bili pozitivno povezani s kakovostjo življenja. Bolniki so najpogosteje izrazili potrebe po naslednjih podrocjih: obvladovanje simptomov, telesno zdravje, družba, gospodinjske spretnosti, hrana in priprava obrokov. Potrebe bolnikov niso bile zadovoljene na naslednjih podrocjih: družba, informacije o stanju in zdravju, stanovanje, telesno zdravje, zaposlitev in dnevne aktivnosti, duševna stiska, denar, ugodnosti in spolno izražanje.
Zakljucki: Vecina bolnikov dobiva premalo pomoci od lokalnih služb, zlasti na podrocju obvladovanja znakov duševne motnje. Bolniki so bili bolj zadovoljni s pomocjo, ki so jo dobili od svojcev in prijateljev na podrocju socialnih potreb. Bolniki na splošno zelo slabo poznajo obstojece možnosti pomoci pri zadovoljevanju potreb, zato je treba izobraževanju bolnikov nameniti vecjo pozornost pri klinicnem delu. Z nadaljnjimi raziskavami je potrebno ugotoviti, koliko se razlicne vrste pomoci medsebojno dopolnjujejo in kako bi lahko ucinkovitost pomoci še izboljšali
[Abstract / English version]
Oviranosti in potrebe po rehabilitaciji ambulantnih bolnikov s shizofrenijo
Author: Matjaž Groznik
Mentor: doc.dr. Milan Licina, dr.med.; as.dr. Rok Tavcar, dr.med
Background: Schizophrenia is a chronic mental disorder, which interferes with patient daily activities and social role. Most of patients are hospitalised only briefly and they continue treatment as outpatients. In 1996 a Slovenian study found high correlation between quality of life score and global functioning of outpatients with schizophrenia. Main hypothesis was that social, demographic and disease-related characteristics influence the global functioning, disabilities and needs for rehabilitation of outpatients with schizophrenia. The aim of this study was to find out the symptoms, disabilities and needs of outpatients with schizophrenia. Differences between males and females were also assessed.
Methods: Fifty schizophrenic outpatients (5% sample, 31 males, 19 females), receiving maintenance depot neuroleptic therapy were included in a cross-sectional study. Patients were interviewed using Krawiecka Scale, Quality of Life, Global Assessment Scale, Camberwell Assessment of Need Scale. Social-demographics data and therapy were recorded. T-tests and chi-square tests were used.
Results: Patients were on average 43 years old. They had 11 years of education. Females were employed longer than males (p<0,01). Two thirds of patients had disability pension. Most patients lived with their parents while females had more frequent contacts with their partners than with their parents. In males the illness began on average four years earlier than in females, but the difference was not significant. The mean duration of illness was fourteen years, almost half patients had cormorbid somatic illness. Alcohol abuse was present in one fifth of patients and one tenth were dependent. The mean GS score was 60, 57 in males and 66 in females (p<0,01). The symptoms were less pronounced in females and moderately diminished their functioning, while in males the more severe symptoms strongly influenced their functioning. The domains of quality of life were rated between two and four. This shows that patients were moderately disabled in interpersonal contacts, employment and psychopathological symptoms. Female sex, broader social network and longer period of employment were positively related with quality of life. The most frequent needs were: management of psychotic symptoms, general health, company, housekeeping skills and meals. The needs were not satisfied in following domains: company, information about condition and treatment, accommodation, physical health, daytime activities, psychological distress, money, benefits, sexual expression.
Conclusions: Help of local services is insufficient, particularly in management of psychotic symptoms. Patients were more satisfied with help of their relatives and friends in social needs. The knowledge on available services was low, therefore the patients need more information on this matter. Further research should evaluate the integration of different services and how to improve the provision of adequate help.