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Yıl:2019; Cilt: 30; Sayı: 4>> Özet
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Türk Psikiyatri Dergisi; 2019;30(4):245-252
Ciddi Ruhsal Hastalığı Olan Bireylerde Olgu Yöneticiliği: 24 Aylık Uygulama Sonuçları
A İncedere, M Yıldız
Kocaeli Üniversitesi, Kocaeli
Amaç: Bu çalışmanın amacı ciddi ruhsal hastalığı (CRH) olan bireyler için olgu yöneticiliği uygulaması yapmak ve bu uygulamanın 24 aylık sonuçlarını değerlendirmektir. Yöntem: Çalışmaya şizofreni ve şizoafektif bozukluk tanısı alan, son bir yılda en az bir alevlenme yaşayan, tedavi uyumu bozuk olan, bir işte çalışmayan, bağımsız yaşayamayan ve çalışmaya katılmaya onay veren 34 hasta alındı. Olgu yöneticiliği bir profesyonel tarafından hastaların gereksinimine göre ayarlanan aralıklarla evde, dernekte, hastanede ve iş yerinde hastalarla, aile üyeleriyle ve işverenlerle görüşmeler yapılarak yürütüldü. Hastalar başlangıçta, 6. ay, 12. ay ve 24. ayda işlevsellik, klinik şiddet ve tedaviye uyum, aileler yük açısından değerlendirildi. Bulgular: Çalışma 24 ayda 30 hasta ile tamamlandı. Hastaların yaş ortalaması 36, ortalama eğitim süresi 11 yıl, ortalama hastalık süresi 13 yıldı. Çoğu erkek, bekâr ve anne-babası ile birlikte yaşamaktaydı. Takip sürecinde tüm hastalar önerilen iyileştirim programlarına katıldı, tedaviye uyumları, işlevsellikleri anlamlı düzeyde arttı. Hastane yatış sayısında önceki 24 ayla karşılaştırıldığında belirgin azalma oldu. Ailelerin yüklerinde azalma saptandı. Takip süresince 10 hasta işe başladı, bunların 3’ü işi bıraktı. Sonuç: Klinik iyileşmede, toplumsal ve mesleki işlevselliğin artmasında, hastane yatışının azalmasında etkili olduğu görülen olgu yöneticiliği uygulamasının CRH’si olan bireylerin iyileştirim çalışmalarında rutin olarak yer alması gerektiği söylenebilir
Case Management for Individuals with Severe Mental Illness: Outcomes of a 24-Month Practice
Objective: The aim of this study is to conduct a case management model on a group of individuals with severe mental illness (SMI) and to evaluate the outcomes during a 24-month follow up. Method: A total of 34 patients diagnosed with schizophrenia or schizoaffective disorder with at least one exacerbation over the last year, poor treatment compliance, who were unemployed and unable to live independently and who gave consent to participate were included to the study. Case management was conducted by a medical professional in the house, schizophrenia association, hospital, and workplace of the patients by interviewing the patients, family members, and the employers of the patients, at intervals arranged according to the need of each patient. Patients were assessed at baseline stage, the sixth, 12th and the 24th month regarding functionality, clinical condition, treatment compliance and family burden. Results: The study was completed in 24 months with 30 patients with a mean age was 36, mean education level of 11 years, and a mean illness duration of 13 years. The majority consisted of unmarried males living with their parents. During the follow up, every patient participated in the recommended rehabilitation programs with, improvement in treatment adherence and functionality. A significant decrement was detected in the number of hospitalizations when compared to the history before the start of the study. Family burden decreased. Ten patients got employed and 3 patients left work. Conclusion: It can be concluded that case management hypothesized to be beneficial for people with SMI with positive outcomes on clinical recovery, improved social and vocational functionality and reduced incidences of hospital stay should be included as a routine psychosocial rehabilitation service.

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