社区慢性精神分裂症患者认知功能损害相关因素分析

目的 了解社区慢性精神分裂症患者认知功能损害的影响因素，为采取有效干预措施提供科学依据。方法 于2015年2-4月采用分层整群随机抽样法，抽取江苏省无锡市江海、广益、蠡湖、雪浪4个街道在册管理的慢性精神分裂症患者为调查对象，年龄18~60岁。采用一般情况调查表、阳性与阴性症状量表（PANSS）、社会功能缺陷筛选量表（SDSS）、华文认知能力量表（CCAS）进行入户调查和认知能力评估。结果 305例社区慢性精神分裂症患者中，认知功能损害173例，发生率为56.72%，其中临界状态、轻度缺损、中度缺损分别占34.10%、20.98%和1.64%；logistic回归分析结果显示，以受教育年限≥13年为参照组，受教育年限0~6年的患者认知功能损害的危险性为5.434倍，以SDSS评分<2分为参照组，SDSS评分6~9分、≥10分的患者认知功能损害的危险性为2.904、4.547倍；竞争性就业（OR=0.330）、庇护性就业（OR=0.315）、纳入个案管理（OR=0.204）、未治精神病期<1年（OR=0.402）、家庭人均月经济收入2 000元以上（OR=0.621）、对患者关心（OR=0.847）是认知功能的保护因素，住院2次以上（OR=2.832）、临床表现阴性症状为主（OR=1.207）为认知功能的危险因素。结论 社区慢性精神分裂症患者认知功能损害明显，社区精神卫生服务应加强对精神疾病的早发现、早干预，推行个案管理，改善患者的就业保障和生存环境，是防治认知功能损害的有效措施。

Relevant factors to cognitive impairment among community chronic schizophrenia patients

Objective To explore relevant factors to cognitive impairment among community patients with chronic schizophrenia in Wuxi municipality and to provide scientific evidences for making effective intervention measures.Methods With stratified randomized cluster sampling,all chronic schizophrenia patients aged 18-60 years and registered in four communities (Jianghai,Guangyi,Lihu,and Xuelang) in Wuxi city were enrolled in this study.A general questionnaire,Positive and Negative Syndrome Scale (PANSS),Social Disability Screening Schedule (SDSS) and Chinese Cognitive Ability Scale (CCAS) were used in household survey.Binomial logistic regression method was used to analyze the influencing factors.Results Of the 305 chronic schizophrenia patients completing the entire survey,56.72% had cognitive impairment and 34.10%,20.98%, and 1.64% had critical state,mild,and moderate cognitive impairment. The results of multivariate logistic regression analyses showed that the cognitive impairment was associated with education (odds ratio[OR]=5.343 for the patients having the education of 0-6 years compared to those having the education of ≥13 years) and SDSS score (ORs=2.904 and 4.547 for the patients with the scores of 6-9 and ≥10 point compared to those with the score of < 2);the result also revealed that the protective factors of cognitive impairment included competitive employment (OR=0.330),sheltered employment (OR=0.315),being covered by case management (OR=0.204),the duration of untreated psychosis less than 1 year (OR=0.402),familial monthly income per capita of more than 2 000 RMB yuan (OR=0.621),and concern to the patient (OR=0.847) and the risk factors included being hospitalized more than 2 times (OR=2.832) and clinical manifestations of negative symptoms (OR=1.207).Conclusion Early detection and intervention,case management,improvement in patient's employment and survival environment are helpful to the prevention of cognitive impairment among chronic schizophrenia patients.