首发精神分裂症患者10年随访研究

目的:探讨首发精神分裂症患者远期预后及其影响因素.方法:运用标准化评定工具对146例首发精神分裂症患者进行10年随访及预后评定,对预后有关影响因素作单因素分析和Logest回 归多因素分析.结果:首发精神分裂症患者10年随访时总体结局良好者23例(19.2%),一般者34例(28.3%),不良者63例(52.5%).单因素分析有11项观察指标与预后有关,多因素分析显示远期预后主要影响因素依次为病前职业功能水平、治疗依从性、起病形式和家庭关系.结论:首发精神分裂症患者远期预后受生物、心理、社会多种因素影响,总体结局较差,其中部分影响因素可进行干预.     

首发精神分裂症患者近期疗效的影响因素

目的系统了解首发精神分裂症患者近期疗效(住院治疗约70~90天)的影响因素。方法采用前瞻性研究方法,应用简明精神病评定量表、阴阳性症状评定量表、社会支持评定量表、生活事件问卷、大体功能评定量表等工具,对符合CCMD-3诊断标准的114例住院精神分裂症患者进行评估。结果首发精神分裂症患者近期疗效的主要影响因素为:家庭社会支持、注意障碍、意志减退、病前职业功能水平、思维贫乏、情感淡漠及起病的快慢。结论为改善精神分裂症病人的预后,应加强心理社会干预措施的改进与研究。     

影响首次住院精神分裂症患者复发的多因素判别分析

目的　系统探讨首发精神分裂症患者复发的影响因素。方法　采用一系列标准化评定工具对 2 0 1例首发精神分裂症住院患者出院后进行 1年的随访 ,评估复发者与非复发者的临床特征和影响疾病复发的因素。结果　首发住院精神分裂症病人出院后 1年内的复发率为 2 1.3 %。逐步判别分析提示 ,病前职业功能水平、随访期间的家庭社会支持及出院后维持治疗是影响疾病复发的主要因素。据此 3个因素预测病人复发的准确性为 82 .6%。结论　疾病的复发受多种因素的影响 ,而可人为干预的因素起重要作用。     

精神分裂症临床结局评价及影响因素的研究现状

精神分裂症作为一种具有高致残率、高复发率的重性精神疾病，通常伴随较差临床结局， 而预后结局始终是临床治疗及研究的重点。以往临床上针对精神分裂症患者结局的评价方式主要依靠 单一的症状学描述及客观指标，而现如今评价患者结局方式已向结合评价患者主观感受的多元化方式迈 进，如主观幸福感及生活满意度等，从而使结局评价更为准确。分析直接影响患者结局的主要因素能够 为病因学研究提供思路且有助于制定个体化治疗策略，增加对疾病了解。依据生物-心理-社会理论， 从未治期、发病年龄、心理运动、心理弹性、家庭环境因素及社会环境因素方面进行综述和分析，并以此为 基础指出未来临床结局研究方向，以期为进一步探究结局影响因素路径进而改善干预措施提供理论指导。     

首发精神分裂症患者营养状况调查及影响因素研究

目的 调查首发精神分裂症患者的营养不良状况，并分析其影响因素。方法 采用单纯随机抽样法，选取2020年1月至2022年6月于武汉市精神专科联盟机构入院的450例首发精神分裂症患者为研究对象。入院后收集患者的一般资料，根据欧洲营养不良风险筛查2002标准将首发精神分裂症患者分为营养不良组和营养正常组。采用单因素分析和多因素Logistic回归模型分析影响首发精神分裂症患者营养不良的因素。结果 450例首发精神分裂症患者中，营养不良患者占19.11%(86/450)。单因素分析结果显示，两组患者年龄、体重指数、有无配偶、是否合并骨质疏松症和是否拒食比较，差异有统计学意义（t/χ2=5.066、9.608、5.399、4.712、11.102;P<0.05）。多因素Logistic回归分析结果显示，年龄大（OR=1.446,95%CI=1.148～1.823）和拒食（OR=4.306,95%CI=1.865～9.944）是首发精神分裂症患者营养不良的危险因素（P<0.01），而体重指数高（OR=0.871,95%CI=0.782～0.871）是患者营养不良的保护因素（P<0...     

首发及慢性精神分裂症患者自知力影响因素分析

目的:探讨首发和慢性精神分裂症患者自知力的影响因素。方法:46例首次发病精神分裂症患者(首发组)及140例慢性精神分裂症患者(慢性组)的人口学及临床资料,并分别于入院及出院时进行阳性与阴性症状量表(PANSS)和自知力与治疗态度问卷(ITAQ)评估;分析影响患者自知力的因素。结果:首发组年龄、病程及本次住院时间与慢性组比较差异有统计学意义(P均0.05);两组治疗前PANSS评分及治疗前后PANSS评分变化值比较差异无统计学意义;治疗前ITAQ总分首发组明显低于慢性组(P0.01);治疗后两组间ITAQ变化值比较差异无统计学意义。以ITAQ评分变化值为因变量,首发组PANSS中阳性症状及阴性症状分变化值、住院时间及治疗前的自知力进入回归模型(P0.05或P0.001);慢性组中患者治疗前的自知力及PANSS中阴性症状和阳性症状评分变化值进入回归模型(P均0.01)。结论:控制临床症状是改善首发和慢性精神分裂症患者自知力的主要影响因素;适当延长住院时间可能有助于首发患者自知力恢复。     

首发青少年精神分裂症药物疗效的纵向比较

目的　了解利培酮、氯氮平、氯丙嗪、氟哌啶醇 4种抗精神病药物治疗首发青少年精神分裂症患者的近期和远期疗效。方法　将首发青少年精神分裂症 2 36例分成利培酮组、氯氮平组、氟哌啶醇组及氯丙嗪组 ,采用BPRS及TESS在患者首次住院治疗前及治疗后 2、4、6、8周进行评定 ,并观察 4组药物的副反应 ;对 4组患者出院后 3年内进行随访 ,并利用BPRS、TESS及SDSS每年评定 1次。结果　在首次住院中 ,4种抗精神病药物在治疗精神分裂症症状方面的近期疗效基本相同 ,但在药物副作用方面 4组患者有显著差异 ;在 3年随访中 ,4组患者在中断治疗、社会功能恢复等方面也有显著差异。结论　非典型抗精神药物的远期疗效优于典型抗精神病药物 ,提示在治疗青少年精神分裂症患者时可首选利培酮或氯氮平等非典型抗精神病药物     

精神分裂症快速缓解的影响因素分析

目的：探讨精神分裂症快速缓解的影响因素。方法：在533例住院精神分裂症患者中，有109例为快速缓解精神分裂症患者；对照组按照与快速缓解组1：1的比例分别在不同性别的非快速缓解的424例精神分裂症患者中随机选取。对两组资料进行比较。结果：精神分裂症快速缓解的比率为20.5％。快速缓解组与对照组相比，在首发年龄、治疗前病程、总病程、起病形式、症状特点、诊断分型以及文化程度、有无诱因、病前1年社会功能、住院次数、服药依从性、社会支持方面差异显著。二项Logistic回归分析显示，精神分裂症快速缓解的影响因素依次为服药依从性、病前1年社会功能、社会支持、起病形式、症状特点、总病程。结论：在治疗精神分裂症患者时应注意多因素的影响，尤其注重发挥人为干预因素的作用。     

首发与复发精神分裂症患者家庭功能对其生活质量影响的比较

目的 探讨首发与复发精神分裂症患者家庭功能对其生活质量影响的差异。方法 2018 年 7—12 月采用便利抽样的方法于四川大学华西医院心理卫生中心住院部对符合纳入排除标准的46 例首 发及88 例复发精神分裂症患者进行调查，采用一般资料、家庭功能评定（FAD）量表（包括沟通、角色、问 题解决、情感反应、情感介入、行为控制和总功能）、家庭亲密度及适应性量表（FACES Ⅱ -CV，包括亲密 度和适应性）以及精神分裂症患者生活质量量表（SQLS，包括心理社会、动机和精力、症状和不良反应） 进行调查并进行组间比较，采用相关分析及多元逐步回归法分析两组家庭功能对其生活质量的影响并 探讨其差异。结果 首发与复发精神分裂症患者在家庭沟通和亲密度方面差异均有统计学意义（t值分 别为2.45、-2.14，均P ＜ 0.05）。复发患者的SQLS 总分与FAD 和FACES 各维度之间均存在相关关系（均 P＜ 0.05），而在首发患者中，只有沟通（r=0.32， P＜ 0.05）和一般功能（r=0.32， P＜ 0.05）与动机和精力相 关。对于首发精神分裂症患者，家庭沟通（β=0.32，P=0.03）是其生活质量的影响因素，而一般功能（β=0.29， P=0.02）和家庭角色（β=0.24，P=0.04）是复发患者生活质量的影响因素。结论 家庭沟通不良的首发精 神分裂症患者生活质量较低，而对于复发精神分裂症患者，家庭角色和家庭一般功能较差者其生活质 量较低。     

《上海精神医学》2000年新12卷分类索引

1.精神医学总论及基础理论二十一世纪中国精神医学的思考老年抑郁症的神经心理学及SPECT研究阿尔茨海默病的Ap表达与APOE、PSI基因的 相关分析精神分裂症神经系统软体征及其相关因素的研究事件相关电位的临床应用加用氟西汀对氯氮平疗效及血浓度的影响常用精神药物利用指数的分析抗精神病药对肝功能和心脏的影响酒依赖的脑CT对照研究精神分裂症患者氯氮平治疗前后脑脊液生长激素 水平的测定203例精神病患者多项音乐感受性测查焦虑症患者脑血流灌注的SPECT研究进展反移情可否开放?神经心理测查对预测首发精神分裂症近期预后 的研究血…     

精神分裂症患者脑CT与临床的10年随访研究

目的探讨精神分裂症的脑萎缩与临床表现的相关性。方法对３２例精神分裂症患者的脑ＣＴ与临床进行了１０年的随访研究，采用简明精神病评定量表、阴性症状量表、阳性症状量表、社会功能缺陷筛选量表、简易智力状态检查对其临床症状、社会功能和智能状况进行评定。结果１０年前３２例患者中有５例（１６％）脑萎缩，１０年后为１０例（３１％）脑萎缩；８例脑室大小正常，但双侧脑室不对称；１４例正常。随访时量表评定结果提示，该组患者以阴性症状为主，社会功能下降，认识功能有不同程度的损害，脑萎缩患者与非脑萎缩患者比较，差异未见显著性，但病程明显长于非脑萎缩患者。精神分裂症患者的脑萎缩与精神病家族史、亚型和各项治疗无明显关系。结论精神分裂症患者的脑结构异常与病程呈正相关。     

High prevalence of Human Herpesvirus 8 in schizophrenic patients

Many studies have reported an association between Herpes family viruses and an increased risk of schizophrenia, but the role of Human Herpesvirus 8 (HHV8) has never been investigated. This study aimed to assess HHV8 prevalence in schizophrenic patients as well as the possible association between HHV8 infection and schizophrenia clinical features. We consecutively enrolled 108 patients meeting fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria of schizophrenia and 108 age and sex matched controls. Data about a number of demographic characteristics and potential HHV8 risk factors of infection were collected. Standardized psychopathology measures, disease severity and functioning level were obtained using Positive and Negative Syndrome Scale (PANSS), Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Negative Symptoms (SANS), Scale for the Assessment of Positive Symptoms (SAPS), Clinical Global Impressions (CGI) and Global Assessment of functioning (GAF). The presence of anti-HHV8 antibodies was analyzed using an indirect immunofluorescence assay. A higher prevalence of HHV8 infection in schizophrenic patients than in controls was found. Marital status, having children, sexual behavior and risk factors of blood transmission were not associated with HHV8 prevalence. However, among schizophrenic patients, HHV8 prevalence was statically associated with positive symptoms. To our knowledge, this would be the first report of a possible role of HHV8 in the pathogenesis of schizophrenia. To prove this hypothesis, further investigation of HHV8 in schizophrenia with larger samples is needed.     

Plasma asymmetric dimethylarginine (ADMA) concentrations in patients with first and multiple episode schizophrenia

An increasing number of reports in the literature indicate that asymmetric dimethylarginine (ADMA) regulates nitric oxide generation in numerous disease states. ADMA has been less studied in psychiatric disorders. The purpose of this study was to determine plasma ADMA concentrations in patients with schizophrenia compared to healthy controls. The study was conducted in 49 male patients with schizophrenia and 30 healthy male control subjects. The patient group was 24 first episode and 25 multiple episode schizophrenia participants. All schizophrenic patients were administered the Scale for the Assessment of Negative Symptoms, the Scale for the Assessment of Positive Symptoms (SAPS) and the Brief Psychiatric Rating Scale. Measurement of plasma concentrations of ADMA was accomplished by HPLC. There was a significant increase in the plasma ADMA concentrations in patients with schizophrenia when compared to healthy controls. There were no significant correlations between the plasma concentrations of ADMA and scores of psychiatric rating scales. In the multiple episode schizophrenia subgroup, the mean plasma ADMA concentration was significantly higher than in the first episode schizophrenia subgroup. The study indicate that plasma ADMA concentrations in patients with schizophrenia are elevated.     

Obsessive-compulsive disorder in hospitalized patients with chronic schizophrenia

Obsessive-compulsive (OC) symptoms have been observed in a substantial proportion of schizophrenic patients. In this study, we assessed the rate of occurrence of OC symptoms and the interrelationship between OC and schizophrenic symptoms in 68 hospitalized chronic schizophrenic patients. The patients were interviewed with the Structured Clinical Interview for Axis-I DSM-IV Disorders - Patient Edition (SCID-P) and the appropriate rating scales including the Scale for the Assessment of Positive Symptoms, the Scale for the Assessment of Negative Symptoms, the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Barnes Akathisia Scale, the Abnormal Involuntary Movement Scale, and the Social Behaviour Schedule (SBS). Sixteen patients (23.5%) met the DSM-IV criteria for OCD. A comparison of schizophrenic patients with and without OCD showed that the schizo-obsessive patients were significantly (1.7-fold) more impaired in basic social functioning, as reflected by the SBS score. No significant between-group differences for any of the other clinical variables were found. There was no significant correlation between OC and schizophrenic symptoms within the schizo-obsessive subgroup. The mean Y-BOCS score for the patients with both schizophrenia and OCD was within the typical range (22.8+/-1.7) observed in OCD without psychosis. The findings provide further evidence for the importance of the OC dimension in schizophrenia and may have important implications for the application of effective treatment approaches in this difficult-to-treat subgroup of schizophrenic patients.     

The emergence of social phobia during clozapine treatment and its response to fluoxetine augmentation

BACKGROUND: The underlying neurochemical basis of social phobia has yet to be fully explained, but there are suggestions of serotonergic and dopaminergic dysfunction. The atypical neuroleptic clozapine has been reported to induce anxiety symptoms, probably owing to its effect on serotonergic pathways. We report 12 cases of schizophrenic patients who developed social phobia during clozapine treatment. METHOD: Patients were assessed using the Structured Clinical Interview for DSM-III-R, Patient Version, Scale for the Assessment of Negative Symptoms, Scale for the Assessment of Positive Symptoms, the Liebowitz Social Phobia Scale, and the Brief Psychiatric Rating Scale. They were reevaluated after 12 weeks of cotreatment with clozapine and fluoxetine. RESULTS: In 8 of the 12 cases, symptoms responded (> or = 35% reduction in Liebowitz Social Phobia Scale score) with an adjunctive regimen of fluoxetine. CONCLUSION: Data are discussed in light of neurochemical mechanisms and cognitive adaptations that could explain the onset of anxiety spectrum disorders (such as social phobia) in clozapine-treated schizophrenic subjects during remission of psychotic symptoms.     

Non-verbal behaviour deficits in schizophrenia: an ethological study of drug-free patients

The aims of this study were (i) to define the dimensions of non-verbal behaviour which distinguish between schizophrenic patients and control subjects and (ii) to examine the relationship between patients' non-verbal behaviour and clinical symptoms. The non-verbal behaviour of 28 drug-free patients with schizophrenia according to Research Diagnostic Criteria (RDC) and 25 control subjects was videotaped during interviews and scored according to an ethological scoring system. Patients' symptoms were rated on the Scale for the Assessment of Negative Symptoms, the Scale for the Assessment of Positive Symptoms and the Brief Psychiatric Rating Scale. As a group, schizophrenic patients showed a global restriction of non-verbal expressiveness, as indicated by their lower scores on prosocial behaviour, gesture and conflict. However, some patients had normal ethological profiles. Non-verbal behaviour was largely independent of negative and positive symptoms. Deficits in non-verbal behaviour may play a role in determining or aggravating dysfunctional patterns of relating in schizophrenia. Ethological analysis provides further support for the model that conceptualizes positive symptoms, negative symptoms and disorders of social relationships as three separate dimensions of the schizophrenic syndrome.     

The generalized pattern of neuropsychological deficits in outpatients with chronic schizophrenia with heterogeneous Wisconsin Card Sorting Test results

Forty schizophrenic outpatients and 40 normal subjects were assessed using extensive clinical (eg, Brief Psychiatric Rating Scale, Scale for the Assessment of Negative Symptoms and Scale for the Assessment of Positive Symptoms) and neuropsychological (extended Halstead-Reitan Battery) measures. The schizophrenic patients had multiple neuropsychological deficits on tests of complex conceptual reasoning, psychomotor speed, new learning and incidental memory, and both motor and sensory-perceptual abilities. Neuropsychological impairment correlated more strongly with negative than positive symptoms. Overall, the schizophrenic outpatients showed relatively modest increases in the number of perseverative responses on the Wisconsin Card Sorting Test of abstraction flexibility. A subgroup of these schizophrenic patients seemed to be particularly impaired on the Wisconsin Card Sorting Test. This pattern of results, in conjunction with previous studies, supports the idea that, while some schizophrenic patients may have fixed, frontally based dysfunctions, these dysfunctions may be most prominent, and even fixed, in deteriorated, kraepelinian patients. These data provide evidence for diffuse and far-reaching deficits in a majority of outpatients with chronic schizophrenia.     

One year outcome in first episode schizophrenia

The aim of this study was to identify the predictors of outcome at one year follow-up after the first psychotic episode of schizophrenia. Seventy-nine first-episode schizophrenia patients were assessed monthly with the Brief Psychiatric Rating Scale (BPRS), Scale for Assessment of Positive Symptoms (SAPS), and Scale for Assessment of Negative Symptoms (SANS) after discharge from their first hospitalization. Outcome measures were presence of relapse and rehospitalization, level of global functioning, employment status and severity of symptoms at one year. A total of 33% of the patients had a relapse, and 12.1% were rehospitalized during one year follow-up. Premorbid childhood functionality was worse in patients who had relapse, but there was no correlation between premorbid adjustment scores and BPRS, SANS and SAPS scores at one year. There was no difference in duration of untreated psychosis (DUP) between patients who had relapse and not; however, the patients who had double relapse, had longer DUP than those without relapse. The time period between discharge and rehospitalization was shorter in patients with longer DUP. Functionality in childhood and noncompliance to the treatment independently contributed to the relapse rate. Functionality in late adolescence independently contributed to the Global Assessment of Functioning (GAF) scale score at one year and the GAF score at discharge appeared as a predictor of employment. The results of the present study suggest that treatment compliance and early premorbid adjustment level seem to be important predictors of relapse rate in first episode schizophrenia.