title: Two-year prospective case-controlled study of a case management program for community-dwelling individuals with schizophrenia.
abstract: BACKGROUND
  A community-based rehabilitation program is an essential element of the comprehensive treatment of individuals with schizophrenia.
  
  
  OBJECTIVE
  Assess the long-term effects of a community-based case management program for providing rehabilitations services to individuals with schizophrenia.
  
  
  METHODS
  A total of 730 community-residing participants who met ICD-10 diagnostic criteriafor schizophrenia were enrolled, 380 in the case management group and 350 in the control group from two districts in Shanghai. Case management involved monthly training visits with patients and their co-resident family members that focused on encouraging medication adherence. Participants were assessed every three months for 24 months with the Camberwell Assessment of Need (CAN), Positive and Negative Syndrome Scale (PANSS), WHO-Disability Assessment Scale (WHO-DAS), and the Quality of Life Scale (QOLS). Level of discomfort due to side-effects was also assessed every three months. Individuals who discontinued their antipsychotic medication without physician approval for one month or longer at any time during follow-up were classified as 'self-determined medication discontinuation'.
  
  
  RESULTS
  Compared to the treatment as usual group (i.e., follow-up management every 3 months), by the end of the two-year follow-up those who participated in the case management program had significantly lower rates of medication discontinuation, significantly less severe negative symptoms, lower relapse rates and lower rehospitalization rates. Other factors that had an independent effect on discontinuation of medication included educational level (those with more education had higher discontinuation rates), lack of family supervision of medication, higher dosages of medication, and greater medication-related discomfort.
  
  
  CONCLUSIONS
  Case management is a feasible and effective long-term method for improving the rehabilitation outcomes of community residents with schizophrenia. Our results highlight the need to involve family members in the management of patients' medication, to use the minimum effective dosage of medication, and to aggressively manage all side-effects.
authors.affiliation: Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Meijuan
authors.initials: M
authors.lastname: Chen
authors.affiliation: Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Guojun
authors.initials: G
authors.lastname: Wu
authors.affiliation: Hongkou Mental Health Center, Shanghai, China.
authors.forename: Zuowei
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Hongkou Mental Health Center, Shanghai, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Yan
authors.affiliation: Hongkou Mental Health Center, Shanghai, China.
authors.forename: Jianfang
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Hongkou Mental Health Center, Shanghai, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Ding
authors.affiliation: Hongkou Mental Health Center, Shanghai, China.
authors.forename: Yaqin
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Xuhui Mental Health Center, Shanghai, China.
authors.forename: Shunzeng
authors.initials: S
authors.lastname: Rao
authors.affiliation: Xuhui Mental Health Center, Shanghai, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Zhou
authors.affiliation: Xuhui Mental Health Center, Shanghai, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Ni
authors.affiliation: Xuhui Mental Health Center, Shanghai, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Xuhui Mental Health Center, Shanghai, China.
authors.forename: Yanli
authors.initials: Y
authors.lastname: Su
authors.affiliation: Xuhui Mental Health Center, Shanghai, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Hu
authors.affiliation: Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Zhenghui
authors.initials: Z
authors.lastname: Yi
authors.affiliation: Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Weimin
authors.initials: W
authors.lastname: Yang
authors.affiliation: Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Lisheng
authors.initials: L
authors.lastname: Song
keywords: case management; community-based rehabilitation; discontinuation rate; schizophrenia; social function
references.citation: Community Ment Health J. 2009 Dec;45(6):447-52
references.pmid: 19415489
references.citation: J Formos Med Assoc. 2013 Apr;112(4):208-15
references.pmid: 23537867
references.citation: Eur Psychiatry. 1995;10(3):113-28
references.pmid: 19698326
references.citation: Lancet. 2012 Jun 2;379(9831):2063-71
references.pmid: 22560607
references.citation: Psychiatry Res. 2012 Dec 30;200(2-3):96-101
references.pmid: 22858250
references.citation: Schizophr Bull. 1995;21(4):657-68
references.pmid: 8749892
references.citation: Aust N Z J Psychiatry. 2007 Jan;41(1):2-9
references.pmid: 17464675
references.citation: Psychiatr Serv. 2001 May;52(5):631-6
references.pmid: 11331797
references.citation: Schizophr Bull. 1998;24(1):37-74
references.pmid: 9502546
references.citation: Br J Psychiatry. 2004 Apr;184:346-51
references.pmid: 15056580