Sains Malaysiana 42(3)(2013): 389–397

Remission of Symptoms Among Schizophrenia Patients Receiving Assertive Community Treatment (ACT) in Malaysia: One Year Follow-Up

(Penyembuhan Gejala dalam Kalangan Pesakit Skizofrenia yang Menerima

Rawatan Komuniti Asertif di Malaysia:  Susulan Satu Tahun)

Rahima Dahlan

Department of Psychiatry and Mental Health, Hospital Kajang, Jalan Semenyih

43000 Kajang, Selangor

Marhani Midin* & Hatta Sidi

Psychiatric Department, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre

Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia

Diserahkan: 6 April 2012/Diterima: 17 Julai 2012

ABSTRACT

Assertive community treatment (ACT) is one of the most important elements of mental health care reform in Malaysia. Many studies worldwide have reliably found that ACT has positive impact on several outcome domains such as reduced hospitalization rate, improvement of symptoms and quality of life. This study aimed to assess the outcome of ACT in the aspect of symptom remission and its influencing factors among patients with schizophrenia in the urban city of Kuala Lumpur. A cross sectional study was conducted on 155 patients with schizophrenia who received ACT in Hospital Kuala Lumpur (HKL). The selection was made by simple random sampling. The abbreviated Brief Psychiatric Rating Scale (BPRS) was used to determine the status of symptom remission. The socio demographic and relevant clinical data were also assessed. A total of 76% (118) was noted to be in remission. According to logistic regression, the strongest predictor of patients receiving ACT with symptom remission was having good social support (p<0.001) and with higher educational level (p=0.024). The study revealed the effectiveness of ACT in terms of high prevalence of patients with symptom remission. This was despite the model of ACT being studied not fulfilling all fidelity measurements of the standard version of the service. The finding would hopefully act as a propeller for further development in this service area. However, the study needs to be replicated through studies with better designs and involving more psychiatric centers.

Keywords: Assertive community treatment (ACT); brief psychiatric rating scale (BPRS); community psychiatric service; schizophrenia; symptom remission

ABSTRAK

Perawatan komuniti asertif (ACT) merupakan satu perubahan penting dalam perkembangan perkhidmatan kesihatan mental di Malaysia. Banyak kajian berkenaan PKA yang dijalankan di seluruh dunia telah memberikan impak positif daripada segi pengurangan kadar kemasukan hospital, penyembuhan gejala penyakit dan kualiti kehidupan. Kajian ini bertujuan untuk menilai PKA daripada segi penyembuhan gejala penyakit dan faktor-faktor yang mempengaruhinya dalam kalangan pesakit skizofrenia di bandaraya Kuala Lumpur. Satu kajian hirisan lintang telah dijalankan terhadap 155 pesakit Skizofrenia yang menerima rawatan PKA di Hospital Kuala Lumpur (HKL) yang dipilih melalui persampelan secara rawakRingkasan Skala Penilaian Psikiatri Ringkas (BPRS) telah digunakan bagi menilai tahap penyembuhan gejala penyakit. Pesakit juga telah menjawab soal-selidik berkenaan demografi dan faktor klinikal yang relevan. Sebanyak 76% (118) didapati sembuh daripada gejala penyakit. Berdasarkan Regresi Logistik, faktor utama yang menyumbang kepada penyembuhan gejala penyakit dalam kalangan pesakit yang menerima PKA ialah sokongan sosial (p<0.001) dan tahap pendidikan yang lebih baik (p=0.024). Kajian ini menjelaskan keberkesanan PKA daripada segi tahap prevalen yang tinggi untuk pesakit sembuh daripada gejala penyakit walaupun model PKA yang dilaksanakan ini tidak menepati piawaian penilaian perkhidmatan seperti yang ditetapkan. Adalah diharapkan keputusan kajian ini mampu memberikan perubahan dalam kemajuan perkhidmatan ini. Walau bagaimanapun, kajian ini memerlukan pengulangan dengan kaedah kajian yang lebih baik dan melibatkan lebih banyak pusat psikiatri.

Kata kunci: Perawatan komuniti asertif (PKA); perkhidmatan psikiatri komuniti; penyembuhan gejala penyakit; skala penilaian psikiatri ringkas (BPRS); skizofrenia

RUJUKAN

Andreasen, N.C., Carpenter, J.W.T., Kane, J.M., Lasser, R.A., Marder, S.R. & Weinberger, D.R. 2005. Remission in Schizophrenia: Proposed criteria and rationale for consensus. Am. J. Psychiatry 162: 441-449.

Baker, F., Jodrey, D. & Intagliata, J. 1992. Social support and quality of life of community support clients. Community Mental Health Journal 28(5): 397-411.

Chan, L.F., Phang, C.K., Loo, T.H., Ong, L.Y., Tuti Iryani, M.D., Hazli, Z., Suarn, S., Rabaiaah, M.S. 2010. Factors influencing in-patient duration among insanity acquittees in a Malaysian Mental Institution. ASEAN Journal of Psychiatry 11(1): 25-35.

Christopher, F., David, Y., Bryan, M., Mark, T., Keith, F., Alan, C., Joanne, H., Gary, S., Richard, W. & Burns, T. 2009. Managing Schizophrenia in primary care: The utility of remission criteria as outcome indicators. Mental Health in Family Medicine 6: 107-112.

Clareci, S.C., Waleska, T.C., Marina, B., Arminda, L.S., Mery, N.S.A. & Jose, O.P.F. 2005. Factors associated with low quality of life in Schizophrenia. Cad. Saude Publica, Rio de Janeiro 21(5): 1338-1348.

Haro, J.M., Norick, D., Suarez, D., Alonso, J., Lipine, J.P. & Ratcliffe, M. 2006. SOHO study group. Remisssion and relapse in the outpatient care of Schizophrenia: Three year results from the Schizophrenia outpatient health outcomes study. Journal of Clinical Psychopharmacology 26(6): 571-578.

Li, C.T., Su, T.P., Chou, Y.H., Lee, Y.C., Liu, M.E., Ku, H.L., Shan, I.K. & Bai, Y.M. 2010. Symptomatic resolution among Chinese patients with Schizophrenia and associated factors. J Formos Med. Assoc 109(5): 378-388.

Lisa, A.A. & Dilip, V.J. 2004. Sustained remission of Schizophrenia among community-dwelling older outpatients. Am J Psychiatry 161: 1490-1493.

Malaysia’s Country Report. 2008. Asia-Pacific community mental health development project http://www.aamh.edu.au. html [20 October 2009].

McGrew, J.H., Bond, G.R., Dietzen, L., McKasson, M. & Miller, L.D. 1995. A multisite study of client outcomes in assertive community treatment. Psychiatric Services 46(7): 696-701.

Overall, J.E. & Gorham, D.R. 1962. The Brief Psychiatric Rating Scale. Psychological Report 10: 799-812.

Minas, H,, Zamzam, R., Midin, M., Cohen, A. 2011. Attitudes of Malaysian general hospital staff towards patients with mental illness and diabetes. BMC Public Health 11:317.

Rasidi, M.S. 2011. Hospital-based community psychiatry in Malaysia. In: Revision course in psychiatry for postgraduate Master of Medicine (Psychiatry) students: 21-26 February. Kuala Lumpur.

Review of Best Practices in Mental Health Reform. Case Management/assertive community treatment. http://phac-aspc.gc.ca/mh-sm/pubs/bpreview/pdf/e_revsec1-1.pdf 20 May 2010.

Young, K.W. 2006. Social support and life satisfaction. International Journal of Psychosocial Rehabilitation 10(2): 155-164.

ZamZam, R., Midin, M., Lim, S.H., Eng, J.Y., Ahmad, S.N.A., Azman, S.F.A., Borhanudin, M.S. & Radzi, S.M. 2011. Schizophrenia in Malaysian families: A study on factors associated with quality of life of primary family caregivers. International Journal of Mental Health Systems 5:16.

*Pengarang untuk surat-menyurat: marhanimidin@yahoo.com