贫困精神分裂症病人免费服药3年临床分析

目的评估免费服药对社区贫困精神分裂症病人的效果。方法通过对119例社区贫困精神分裂症病人随访,比较免费服药治疗3年前后,病人在服药依从性、病情稳定性、社会功能性、住院频繁性、社会破环性方面的变化,分析实行免费服药治疗的疗效。结果119例贫困精神分裂症病人能遵医服药者从免费治疗前39例提高到108例,增加了63.9%;同时间断服药者从45例减少到9例,减少了80.0%;不服药者从35例减少到2例,下降了94.3%。病情的稳定好转率从27.7%提高到94.2%。社会功能得到改善,不能自理生活者从48例下降到9例,下降了81.3%。再住院次数及攻击行为明显减少,未住院病人从15例增加到106例,增加了85.8%;无冲动行为者从48例增加到98例,增加了51.0%。结论贫困精神分裂症病人需要正规系统治疗,免费服药是病人的康复途径之一,提高了病人的生活质量,减轻了经济负担,获得了治安稳定的社会效益。     

上海某城区精神分裂症患者药物维持治疗纵向观察

目的了解上海市嘉定区2001年以来精神分裂症患者药物维持治疗情况的变化。方法将嘉定区2007年7月底的在册精神分裂症患者药物维持治疗的变化情况与2001年到2006年的在册精神分裂症患者的药物维持治疗情况进行比较,了解本区2004年8月1日实行对贫困精神病患者门诊免费送药后,患者药物治疗率的纵向变化情况。结果免费送药后精神分裂症患者的药物治疗率明显提高,2007年比免费送药前的2003年提高了33.09%。结论提高药物治疗率对减少精神分裂症的复发至关重要。     

社区免费服药对精神分裂症患者服药依从性及复发的影响

目的:探讨社区免费服药对精神分裂症患者服药依从性及复发的影响. 方法:64例精神分裂症患者随机分成研究组和对照组各32例,均给予利培酮常规治疗.研究组给予社区定期免费给药及健康教育,对照组不给予社区免费给药及健康教育.两组于入组时、入组后6个月和12个月采用简明精神病评定量表(BPRS)、自知力与治疗态度问卷量表(I...     

荆门市贫困精神疾病患者免费服药三年疗效观察

目的评估荆门市贫困精神疾病患者免费服药治疗效果,为进一步落实精神疾病防治康复工作提供科学依据。方法通过填写贫困精神疾病患者医疗救助项目服药疗效评估表,由精神科医师按照《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)诊断筛查,对200例符合免费服药条件的贫困精神疾病患者进行服药前后的对比,分析实行免费服药治疗效果。结果坚持按医嘱服药的人数从项目实施前的36例增加到170例,增加了78.8%(P0.01)。病情稳定者从48例增加到130例,增加63.0%;病情偶有波动从80例减少到52例,减少35.0%;病情不稳定者坚持服药从72例减少到18例,减少75.0%(P0.01)。免费服药前住院126例次,免费服药后住院44例次,住院例次减少65.0%。自我价值体现方面,从事基本家务劳动从80例增加到140例;外出务工从20例增加到40例;完全依赖家人生活从100例减少到20例。结论对于贫困家庭,免费服药是有效的康复途径之一,既能减轻患者的家庭经济负担,又能提高患者的生活质量。     

精神分裂症患者服药依从性的调查

目的:调查社区精神分裂症患者服药依从性及其相关因素。方法:对287例免费服药治疗的精神分裂症患者进行病程,一般情况调查表,自知力,服药依从性与简明精神病评定量表(BPRS),社会功能缺陷筛选量表(SDSS)及治疗中出现的症状量表(TESS)的评定与分析。结果:服药依从者70.7%;病程>5年者依从性比≤5年者差;文化程度初中及以下;服用经典抗精神病药组(包括氯氮平);自知力障碍重者依从性差;BPRS总分其思维障碍、敌对猜疑因子分越高者依从性越差;SDSS及TESS(严重度)评分越高者依从性越差。结论:提示患者文化程度高、社会支持系统好、药物不良反应小、有自知力者服药依从性好。     

老年精神病人诊治分析

目的了解住院老年精神病人诊疗情况及应对措施。方法采取定点调查法,于2014-07-23记录在我院住院的105例老年精神病人当日用药与康复等治疗情况。结果诊断主要为精神分裂症占39.05%,老年痴呆占42.86%,老年性情感障碍占16.19%;合并躯体疾病者65例(61.90%)。105例患者均参与康复治疗,其中单一用药69例,合并用药36例。以抗精神病药治疗为主,83例使用第二代抗精神病药,1例使用第一代抗精神病药。结论加强老年性精神病的诊断和治疗,同时关注合并躯体疾病的治疗,在药物治疗的同时,加强康复治疗和心理治疗,可改善老年患者的各种功能,提高生活质量。     

城区精神分裂症患者药物维持治疗情况调查

2006年以来，在国家的支持下，我市对贫困重性精神疾病患者实行免费给药的政策，使城区精神分裂症患者治疗率提高。本调查对其服药治疗情况进行对比，报告如下。     

免费投药对精神分裂症疗效的一年随访研究

目的评估免费投放抗精神病药对精神分裂症患者的疗效。方法对100例非急性期精神分裂症患者配对后按随机数字表随机分为2组,免费投放组48例和对照组52例。免费投放组由医生定时上门免费发药并巡诊,对照组自行选择普通门诊治疗,随访1年。采用简明精神病评定量表（BPRS）和社会功能缺陷筛选量表（SDSS）评估,同时监测复发、再住院、就业及服药依从情况。结果随访结束时免费投放组BPRS,SDSS评分,复发率、再住院率、就业率均显著优于对照组（P〈0.05）,而且服药依从性更好（P〈0.01）。结论免费投放抗精神病药对精神分裂症患者的疗效优于普通门诊,能减少复发,提高患者的依从性,改善患者的社会功能。     

精神病人社区服药情况分析

精神病是一种病程迁延易复发的疾病，而维持药物治疗是预防复发的关键。作者对我院１２８例再入院精神病人社区服药情况进行调查分析，现报告如下。１资料和方法本组资料为１９９７年７月～１９９８年６月住入本院的再入院病例，共计１２８例，其中男９０例，女３８例；年...     

贫困精神病患者免费服药疗效评估

自2004年11月起，我区实行贫困精神病患者免费医疗，现对2年来患者治疗前后的疗效进行评估，报告如下。     

Major Psychiatric Disorders Subsequent to Treating Epilepsy by Vagus Nerve Stimulation

Purpose. The goal of this work was documentation of incidence, phenomenology, pathogenesis, and treatment of psychiatric disorders occurring subsequent to treating epilepsy by vagus nerve stimulation (VNS).Methods. In a series of 81 patients treated by VNS, all patients who developed major psychiatric complications underwent systematic psychiatric evaluation and treatment with psychotropic medication; VNS was modified if necessary.Results. After the seizure frequency was reduced by at least 75%, 7 of 81 patients (9%) developed major psychiatric disorders: Six became severely dysphoric (5 with catastrophic rage and 4 with psychotic symptoms), and one became psychotic. All 7 patients had experienced dysphoric disorders and 2 had experienced psychotic episodes prior to the VNS treatment. Five patients had frequent daily seizures prior to treatment. Remission or satisfactory improvement was achieved with psychotropic medication in 6 patients, aided by decreasing or interrupting VNS in two patients. One patient was noncompliant and suffered a fatal outcome.Conclusion. Severe interictal dysphoric disorders associated with catastrophic rage and psychotic episodes may develop on suppressing seizures by VNS in patients with previous epilepsy-related psychiatric disorders. Patients with multiple daily seizures may be more vulnerable to this occurrence. The phenomenon corresponds to the common finding of interictal dysphoric and psychotic symptoms emerging when inhibitory mechanisms predominate (alternative psychiatric disorders in the absence of seizures, or forced normalization of the EEG). The dysphoric symptom of catastrophic rage appears to occur more often on seizure suppression by VNS than by antiepileptic drugs. Psychiatric intervention, primarily with antidepressant medication, must be available to secure a good outcome; decrease of VNS may occasionally be required.     

Psychotic symptoms in an urban general medicine practice

OBJECTIVE: The authors' goals were to estimate the prevalence of psychotic symptoms among adults attending an urban general medical practice that serves a low-income population and to describe the mental health, social and occupational functioning, and mental health treatment of these patients. METHOD: Data were drawn from a recent study of adult primary care patients (N=1,005) in a large, urban, university-affiliated general medicine practice. During a medical visit, patients completed the psychotic disorders section of the Mini International Neuropsychiatric Interview, the Primary Care Evaluation of Mental Disorders, a drug use disorders screen, the Sheehan Disability Scale, and a questionnaire that probed demographic characteristics, health status, and mental health treatment. RESULTS: Two hundred ten (20.9%) patients reported one or more psychotic symptoms, most commonly auditory hallucinations. There was an inverse correlation between family income and the prevalence of psychotic symptoms and a positive association between prevalence and Hispanic ethnicity. Compared with patients without psychotic symptoms, patients with psychotic symptoms were significantly more likely to have major depression (42.4% versus 12.6%), panic disorder (24.8% versus 4.0%), generalized anxiety disorder (38.6% versus 8.4%), and alcohol use disorder (12.9% versus 5.0%). They were also more likely to report current suicidal ideation (20.0% versus 3.5%), recent work loss (55.0% versus 35.6%), and marital distress (28.6% versus 13.0%). Approximately one-half of the patients with psychotic symptoms (47.6%) had taken a prescribed psychotropic medication during the last month. CONCLUSIONS: Psychotic symptoms were highly prevalent in this primary care practice. These patients were at risk for several common mental disorders and often reported impaired work and social functioning. Future research should clarify the extent to which psychotic symptom reports among Hispanic patients are affected by culturally patterned idioms of distress. Clinicians who work in primary care practices that serve low-income patient populations should routinely inquire about psychotic symptoms.     

Olanzapine therapy in treatment-resistant psychotic mood disorders: a long-term follow-up study

BACKGROUND: Recent studies suggest a role for the atypical antipsychotic olanzapine in the acute treatment of psychotic mood disorders, but long-term data are unavailable. The purpose of this naturalistic study was to determine the long-term effectiveness and tolerability of olanzapine as add-on therapy in psychotic mood disorders. METHOD: Hospital records were reviewed for 125 inpatients at the state psychiatric hospital in Buffalo, N.Y., who received at least 6 weeks of add-on olanzapine treatment for psychotic mood disorders (schizoaffective disorders [bipolar and depressive type], bipolar disorders [I, II, and NOS], and major depressive disorder). A group of schizophrenic patients served as a control group (N = 50). Baseline measures, including age, gender, number of hospitalizations in the 2 years prior to olanzapine treatment, concomitant medications, the Clinical Global Impressions scale (CGI), and the Global Assessment of Functioning-Equivalent (GAF-EQ) and Kennedy Axis V psychological impairment, violence, social skills, and activities of daily living subscale scores, were obtained. Follow-up information was obtained from the patients at least 6 months after initiation of olanzapine or by chart review and discussion with the treating psychiatrist. Patients with a diagnosis of psychotic mood disorders were compared with patients with the non-affective psychotic disorder (schizophrenia) on a variety of outcome measures. RESULTS: Follow-up information was available on 102 patients (82%). Mean follow-up was 15 months; 50 (49%) of the 102 patients remained on olanzapine treatment at follow-up (32 psychotic mood disorder, 18 schizophrenic). The primary reason for discontinuation in both groups was lack of response. Both the psychotic mood disorder and schizophrenic groups had comparable outcomes on the CGI and GAF-EQ. Improvement on the Kennedy Axis V psychological impairment and social skills subscales was seen only in the psychotic mood disorders group (p < .01); both groups showed significant (p < .02) improvement in the violence subscale. Sustained mood-stabilizing effect was evident in only 7/27 (26%) of the psychotic mood disorders patients continuing on add-on olanzapine treatment at follow-up. CONCLUSION: Lack of response was the primary reason for discontinuation of add-on olanzapine in both groups. Mood symptoms predicted a better response to add-on olanzapine in patients with psychotic mood disorders on selective outcome measures. However, only 26% of the patients with psychotic mood disorders sustained a clinically meaningful mood-stabilizing effect with add-on olanzapine treatment at follow-up.     

The additional therapeutic effect of group music therapy for schizophrenic patients: a randomized study

OBJECTIVE: Schizophrenia is one of the most serious mental disorders. Music therapy has only recently been introduced as a form of treatment. The aim of this study was to examine the effect of music therapy for schizophrenic in-patients needing acute care. METHOD: Thirty-seven patients with psychotic disorders were randomly assigned to an experimental group and a control group. Both groups received medication and treatment indicated for their disorder. Additionally, the experimental group (n = 21) underwent group music therapy. RESULTS: Significant effects of music therapy are found in patients' self-evaluation of their psychosocial orientation and for negative symptoms. No differences were found in the quality of life. CONCLUSION: Musical activity diminishes negative symptoms and improves interpersonal contact. These positive effects of music therapy could increase the patient's abilities to adapt to the social environment in the community after discharge from the hospital.     

Effectiveness of electroconvulsive therapy in community settings.

BACKGROUND: Clinical trials indicate that electroconvulsive therapy (ECT) is the most effective treatment for major depression, but its effectiveness in community settings has not been examined. METHODS: In a prospective, naturalistic study involving 347 patients at seven hospitals, clinical outcomes immediately after ECT and over a 24-week follow-up period were examined in relation to patient characteristics and treatment variables. RESULTS: The sites differed markedly in patient features and ECT administration but did not differ in clinical outcomes. In contrast to the 70%-90% remission rates expected with ECT, remission rates, depending on criteria, were 30.3%-46.7%. Longer episode duration, comorbid personality disorder, and schizoaffective disorder were associated with poorer outcome. Among remitters, the relapse rate during follow-up was 64.3%. Relapse was more frequent in patients with psychotic depression or comorbid Axis I or Axis II disorders. Only 23.4% of ECT nonremitters had sustained remission during follow-up. CONCLUSIONS: The remission rate with ECT in community settings is substantially less than that in clinical trials. Providers frequently end the ECT course with the view that patients have benefited fully, yet formal assessment shows significant residual symptoms. Patients who do not remit with ECT have a poor prognosis; this underscores the need to achieve maximal improvement with this modality.     

Psychoses in Parkinson's Disease

Psychotic symptoms occur in up to 40% of patients with Parkinson's disease (PD) and other degenerative parkinsonian disorders, usually but not exclusively in the context of their pharmacologic treatment. We describe the following six psychotic syndromes in PD based on existing literature: (1) hallucinations with preserved insight; (2) medication-induced psychotic disorders (in clear consciousness); (3) delirium; (4) schizophrenia-like psychotic disorders (in clear consciousness and in the absence of medication treatment); (5) schizophrenia with subsequent development of PD; and (6) other psychotic disorders. Psychosis in PD has been noted to be a marker for illness deterioration. Psychotic symptoms can profoundly affect the quality of life for PD patients and their families and may increase the economic burden of this illness. Various approaches have been used to treat psychotic symptoms in PD. We critically review this literature, which is limited, but includes studies indicating promise for "atypical" antipsychotics in these patients. Further elucidation of the phenomenology, course, pathophysiology, and treatment of the different psychotic disorders in PD is urgently needed.     

The prevalence of personality disorders,psychotic disorders and affective disorders amongst the patients seen by a community mental health team in London

BACKGROUND: There is a lack of information regarding the prevalence and co-occurrence of personality disorders, psychotic disorders and affective disorders amongst patients seen by community mental health teams. This study aims to describe the population of patients served by a community mental health team in South London in terms of demographic and clinical characteristics. METHOD: Computerised hospital records and keyworkers' caseloads were used to identify 193 patients. The Standardised Assessment of Personality was used to assess personality disorders and the Operationalised Criteria Checklist was used to assess psychotic and affective disorders. RESULTS: Fifty-two per cent of patients met the criteria for one or more personality disorders, 67 % of patients had a psychotic illness and 23 % had a diagnosis of a depressive disorder. Community psychiatric nurses (CPNs) mainly saw patients with psychotic illnesses. The non-psychotic patients seen by CPNs had extremely high rates of personality disorder. Patients seen by psychiatrists and psychologists had significantly lower rates of personality disorder. CONCLUSIONS: The prevalence of personality disorder is high amongst patients seen by community mental health teams. Possible explanations for this are presented and implications for community care are discussed.     

Right unilateral ECT at 6x seizure threshold: is it effective in the psychoses?

SUMMARY: OBJECTIVE: To date, right unilateral electroconvulsive therapy administered at 6x seizure threshold (6x RUL-ECT) has been described in relation to unipolar depression alone. For clinicians who have developed an experience and confidence in bilateral ECT, the effectiveness of 6x RUL-ECT in other psychiatric disorders, particularly those who are severely ill, has remained untested and therefore unknown. This article describes the results of 6x RUL-ECT in a select series of patients with a nondepressive psychotic illness. METHOD: Six patients with psychotic disorders of nondepressive origin were selected from a recent 2-year retrospective review of 6x RUL-ECT practice. The clinical presentation, ECT parameters, and responses were recorded. RESULTS: Four patients with severe psychotic disorders, two of whom met broad criteria for catatonia, responded to an index course of 6x RUL-ECT. One psychogeriatric patient who had protracted inpatient mania continues to benefit from outpatient maintenance 6x RUL-ECT over 18 months. Two elderly males, in whom seizures were difficult to elicit and maintain, responded poorly. CONCLUSION: 6x RUL-ECT was effective in 4 patients with nondepressive, psychotic disorders. While clinically viable and although memory was not assessed, it is uncertain what advantage 6x RUL-ECT confers over a bilateral electrode placement. The real focus should remain on clinical responsivity.     

Psychosocial treatment compliance scale for people with psychotic disorders

OBJECTIVE: Psychosocial treatment compliance is essential for effective treatment outcomes. A psychometrically valid compliance scale is required for identifying possible obstacles causing treatment non-compliance and testing the effectiveness of compliance therapy. This study developed a scale to measure psychosocial treatment compliance of people with psychotic disorders and established its psychometric properties. METHOD: An initial item pool was generated by literature review and contacts with psychiatric professionals. The content validity and cultural relevancy of this scale were examined by experienced researchers, mental health professionals and mental health consumers which resulted in the 17-item Psychosocial Treatment Compliance Scale (PTCS). Some 108 adults with a DSM-IV diagnosis of psychosis verified by certified psychiatrists were recruited from mental hospitals and social service settings in Hong Kong. Self-stigma, self-esteem, self-efficacy, insight and attitudes to medication of the participants were measured by relevant assessment instruments through interviews. Case therapists then filled in the PTCS and recorded their demographic data. SPSS version 11.0 was used for data analysis. RESULTS: Exploratory factor analysis revealed a two-factor solution (participation and attendance) accounting for 70.74% of the variance. Test-retest reliability and internal consistency were 0.90 and 0.96, respectively, for 'participation'; and 0.86 and 0.87, respectively, for 'attendance'. Its convergent validity was supported by the correlational relationships with measures on self-stigma, self-esteem, self-efficacy, insight and attitudes to medication. CONCLUSION: PTCS is a reliable and valid scale which may be used to measure the compliance to psychosocial treatment of people with psychotic disorders.