精神分裂症复发危险因素的研究

目的 探讨精神分裂症患者的复发危险因素。方法 对226例复发精神分裂症患者的复发危险因素与161例未复发者采用单因素、多因素两种统计方法分析比较。结果 精神分裂症复发的主要危险因素是用药依从性、社会支持、就诊情况、家属对患者的照顾程度。结论 精神分裂症患者的许多复发危险因素是可以干预的。     

精神分裂症复发的危险因素研究

目的　探讨精神分裂症患者复发的危险因素。方法　对 1 1 4例精神分裂症患者进行前瞻性观察和 3年随访研究。结果　Logis tic回归分析筛选出主要危险因素为病前性格、治疗依从性和疗效 ;单因素分析筛选出主要危险因素为治疗依从性、病前性格、婚烟状况、疗效、自知力、生活事件和家族史。结论　复发危险因素的干预 ,对预防和减少精神分裂症的复发十分重要。     

精神分裂症恢复期复发影响因素的研究

目的探讨精神分裂症复发的相关影响因素。方法以2012年~2013年河北省石家庄市第八医院诊断为精神分裂症的192名患者为对象,随访3年,了解患者恢复期的复发情况,运用自制的调查问卷收集患者基础资料、临床资料,采用二分类Logistic回归分析精神分裂症复发影响因素。结果192例精神分裂症患者3年内复发93例,复发率48.44%,多因素分析发现男性,家庭支持一般、差,未婚、离婚,偏执型患者,病程1年,有精神病家族史服药不依从是精神分裂症复发的危险因素。尤其是有精神病家族史(OR=4.837,95%CI:2.514~7.326),服药不依从(OR=3.159,95%CI:1.745~4.467)是精神分裂症复发的主要危险因素。结论精神分裂症患者复发受到遗传、服药依从性、家庭环境、疾病的病程、类型等多种因素的影响,应该针对上述因素来降低精神分裂症患者的复发。     

精神分裂症患者复发危险因素的病例对照研究

为了探讨精神分裂症复发的危险因素,对81例精神分裂症患者的复发情况进行了调查。结果显示:1年内复发率为51.85％,多因素分析筛选出的主要危险因素为社会功能明显差,治疗依从性差,明显的精神刺激和有精神病家族史;单因素分析筛选出的危险因素还有不能定期复诊,药物维持治疗中断,对疾病缺乏认识和病前人格明显缺陷。本文对复发的危险因素和预防复发的措施,进行了讨论。     

首发精神分裂症复发高危因素的回归分析

目的探讨首发精神分裂症5年内复发的危险因素。方法对406例首发精神分裂症患者痊愈后5年内进行随访，并分析复发患者的临床特点。结果5年复发率为70．3％；回归分析发现DUP（duration of untreated psychosis未治疗的精神病期）、依从性、遗传、年龄、是否按医嘱复诊与复发的关系密切，其中坚持按医嘱复诊、服药是减少复发最重要的条件。结论影响首发精神分裂症复发的因素很多，其中最重要的是遗传、DUP、依从性、年龄以及是否按医嘱复诊。     

精神分裂症复发相关因素调查分析

目的探讨精神分裂症患者的疾病复发原因及护理对策。方法对112例复发精神分裂症患者进行了调查分析，了解复发的相关因素。结果患者及家属不能正确依从医嘱进行有效维持治疗是复发的重要因素。结论有针对性地对住院精神分裂症患者进行干预是必要的，尤其是对患者进行心理健康教育。     

精神分裂症复发的危险因素研究

目的：探讨精神分裂症复发的危险因素,方法：对136例临床痊愈的精神分裂症患者进行前瞻性观察随访4年。结果：4年间复发率为65．4％。Logistic回归分析筛选出主要危险因素为停药或不规则服药、低水平的社会适应功能、病前性格;单因素分析筛选出主要危险因素为停药或不规则服药、病前性格、低水平的社会适应功能、婚姻状况、治疗依从性、生活事件和家族史,结论：坚持维持治疗、加强生活技能训练、及时发现和处理复发的早期表现、是降低复发率的有效途径。     

农村精神分裂症患者复发相关因素:Logistic回归分析

目的探讨影响农村精神分裂症患者复发的相关因素。方法选择2012年1月至2012年9月期间在石家庄市第八医院住院达临床痊愈出院的农村精神分裂症患者180例作为研究对象,应用自制复发调查表随访追踪三年,分析农村精神分裂症患者复发的相关因素,为预防复发提供依据。结果最后完成随访的患者(151例)其3年的复发率为74.8%,Logistic回归分析发现影响复发的相关因素依次为性别、药物不良反应、药物依从性,其中药物的依从性是影响复发的最危险性因素。结论影响农村精神分裂症患者复发的因素较多,但男性、较多的药物不良反应,间断服药或停药是患者复发的高危因素,其中提高药物的依从性是预防复发的最重要因素。     

社区精神分裂症患者自杀行为的危险因素分析

目的:探讨社区精神分裂症患者自杀行为的相关危险因素。方法:通过自制调查问卷对成都市青羊区358例登记在册的精神分裂症患者进行调查。根据患者既往是否有自杀行为,分为有自杀行为组和无自杀行为组。采用单因素分析、多因素Logistic回归分析,探讨社区精神分裂症患者自杀行为相关的危险因素。结果:社区精神分裂症患者中发生过自杀行为的占23.5%;有幻觉及妄想(OR=1.857,P0.05)、服药不依从(OR=2.320,P0.01)、照护者对疾病知识完全不了解(OR=2.816,P0.05)是患者发生自杀行为的危险因素。结论:社区精神分裂症患者自杀风险高,患者有幻觉妄想症状及治疗不依从、患者照料者对该病不了解是患者自杀行为的危险因素。     

象山农村精神分裂症患者的复发因素探讨

为了探讨象山县农村精神分裂症患者的复发因素,以便为制 订农村精神分裂症防治措施提供依据。水文对再次住入我院的 303例农村精神分裂症患者复发因素进行调查,现报告如下。     

A prospective 3-year longitudinal study of cognitive predictors of relapse in first-episode schizophrenic patients

BACKGROUND: Cognitive predictors of relapse have been extensively explored only in few long term longitudinal studies of first-episode schizophrenia. METHOD: This study prospectively followed 93 patients with first-episode schizophrenia, schizophreniform disorder, and schizoaffective disorder for 3 years after their first-episode illness. Cognitive domains including verbal intelligence, verbal and visual memory, verbal fluency, and Wisconsin Card Sorting Test performance were investigated as potential predictors of relapse. RESULTS: We found that by the first year 21% patients had relapsed, by the second year 33% had relapsed, and by the third year 40% had relapsed. There was a significant difference in the relapse rate between patients with good adherence and patients with poor adherence to medication regimes. A multiple logistic regression analysis revealed that after controlling for medication adherence, perseverative error in the Wisconsin Card Sorting Test was the only cognitive function that significantly predict relapse with an odds ratio of 2.4. CONCLUSIONS: Cognitive flexibility in set shifting is related to tendency towards relapse in first-episode schizophrenic patients. Other cognitive factors appear not to be related to relapse. Possible mechanisms included the link between prefrontal dysfunction and sub-cortical dopamine system stability, as well as the effects of executive dysfunction on insight impairment and adherence behavior.     

Adjusting the frequency of continuation and maintenance electroconvulsive therapy to prevent relapse of catatonic schizophrenia in middle-aged and elderly patients who are relapse-prone

The purpose of the present paper was to study the effect of continuation electroconvulsive therapy (ECT) on the prevention of relapse in middle-aged and elderly patients with intractable catatonic schizophrenia. It was found that continuation ECT is efficacious to sustain remission for patients who suffer relapse after response to acute ECT despite continuation neuroleptics. However, three patients suffered relapse during continuation ECT, therefore the effect of adjusting the frequency of continuation ECT and maintenance ECT was investigated in these patients with catatonic schizophrenia who relapsed during continuation ECT. These patients with DSM-IV catatonic schizophrenia who relapsed during continuation ECT were treated with more frequent continuation ECT and subsequent maintenance ECT after response to acute ECT. The patients' Brief Psychiatric Rating Scale (BPRS) scores were prospectively evaluated until relapse. Patients were considered to be relapsers if they had a BPRS score >or=37 for 3 consecutive days. The three patients with catatonic schizophrenia who relapsed during continuation ECT were treated successfully with more frequent continuation ECT and subsequent maintenance ECT. No patient experienced a severe adverse effect from continuation or maintenance ECT. More frequent continuation ECT and maintenance ECT deserves consideration in middle-aged and elderly patients with intractable catatonic schizophrenia who suffer relapse during continuation ECT. Large-scale systematic studies are warranted to investigate the optimum use of continuation and maintenance ECT in patients with catatonic schizophrenia.     

The Effect of Paternal Age on Relapse in First-Episode Schizophrenia

Objective:

Multiple etiological and prognostic factors have been implied in schizophrenia and its outcome. Advanced paternal age has been reported as a risk factor in schizophrenia. Whether this may affect schizophrenia outcome was not previously studied. We hypothesized that advanced paternal age may have a negative effect on the outcome of relapse in schizophrenia.

Method:

We interviewed 191 patients with first-episode schizophrenia and their relatives for parental ages, sociodemographic factors at birth, birth rank, family history of psychotic disorders, and obstetric complications. The outcome measure was the presence of relapse at the end of the first year of treatment.

Results:

In the 1-year follow-up period, 42 (22%) patients experienced 1 or more relapses. The mean paternal age was 34.62 years (SD 7.69). Patients who relapsed had significantly higher paternal age, poorer medication adherence, were female, and were hospitalized at onset, compared with patients who did not relapse. A multivariate regression analysis showed that advanced paternal age (OR 1.05, 95% CI 1.01 to 1.10), medication nonadherence (OR 2.37, 95% CI 1.12 to 4.99), and female sex (OR 2.44, 95% CI 1.14 to 5.24) independently contributed to a higher risk of relapse. Analysis between different paternal age groups found a significantly higher relapse rate with paternal age over 40.

Conclusions:

Advanced paternal age is found to be modestly but significantly related to more relapses, and such an effect is the strongest at a cut-off of paternal age of 40 years or older. The effect is less likely to be mediated through less effective parental supervision or nonadherence to medication. Other possible biological mechanisms need further explorations.     

手术戒毒复吸原因及影响因素的对比研究

目的探讨立体定向射频毁损伏隔核手术戒毒后复吸原因及影响因素。方法对2000年7月．2004年11月272例在我院接受定向伏隔核射频毁损手术戒毒的病人进行随访，其中术后复吸58例。分析术后复吸的原因，并与其以往药物戒毒复吸原因及影响因素进行回顾性分析对比研究。结果回到过去吸毒环境、受毒友引诱致复吸17例（29．3％），生活负性事件致复吸30例（51．7％），其他原因致复吸11例，复吸多发生在术后3-6个月。主观欣快感与术前相比无变化28例（48.3％），减弱30例（51．7％），无欣快感增强病例；吸食毒品量及频度与术前相比减少47例（81．0％），无明显变化6例（10．3％），增加5例（8．7％）。结论社会环境因素是手术戒毒复吸的主要原因．心理因素为次要原因。术后3-6个月易发生复吸，吸食毒品欣快感多数减弱或无明显变化。影响术后复吸的因素还与病人受教育程度．吸毒史长短，吸食毒品种类等有关。     

Predicting relapse after a first episode of non-affective psychosis: a three-year follow-up study

BackgroundPreventing relapse during the first years of illness has a critical impact on lifelong outcomes in schizophrenia. A better understanding and improvement in factors which influence relapse should diminish the risk of relapse and consequently improve the outcome of the illness.ObjectiveTo identify factors associated with relapse after 3 years of a first episode in a sample of non-affective psychosis patients who are representative of clinical practice in an epidemiological catchment.MethodWe analyzed socio-demographic and clinical data from a cohort of patients who were treated in a specialized early intervention service and who were at risk of relapse during a 3-year follow-up. Univariate analyses, logistic regression and survival analyses were performed. The analyzed variables included gender, age at onset, duration of untreated psychosis, clinical severity at baseline, insight at baseline, premorbid functioning, substance use, family history of psychosis and adherence to medication.ResultsOf the 140 patients considered to be at risk for relapse, 91 (65%) individuals relapsed at least once over the three-year period. The relapse rates at 1 year and 2 years were 20.7% and 40.7%, respectively. Adherence to medication was the only significant predictor of relapse after a three-year follow-up [hazard ratio (HR) 4.8, 95% confidence interval (CI) 2.9–7.7; p < 0.001]. Comparison of the mean time of relapse between adherent and non-adherent patients also revealed statistically significant differences (933 and 568 days, respectively). 50% of patients will relapse despite being categorized as treatment adherents.ConclusionNon-adherence to medication is the biggest predictive factor of relapse after a first episode of psychosis.     

Sociodemographic and clinical factors associated with relapse in schizophrenia

The aim of the present study was to examine sociodemographic and clinical factors associated with relapse in schizophrenia. The study group consisted of a convenience sample of 40 schizophrenia patients (20 patients each in relapse and remission). Relapse and remission were defined based on clinical criteria (ICD-10 criteria, course since last episode, and duration of remission) and psychometric criteria (scores on Socio-Occupational Functioning Assessment Scale [SOFAS] and Positive and Negative Syndrome Scale for Schizophrenia [PANSS]). The index group was evaluated after the occurrence of current relapse but within 6 months of its onset. Sociodemographic, current psychopathology (PANSS) and functioning (SOFAS), and other (mainly retrospective) variables were assessed with a specifically designed clinical profile sheet, Schedule for Affective Disorders and Schizophrenia Lifetime version, Presumptive Stressful life Events Scale, and World Health Organization Life Chart Schedule for Assessment of Course and Outcome of Schizophrenia. Patients who had relapsed were more symptomatic and exhibited greater dysfunction in comparison to remitted patients. Relapse in schizophrenia was significantly associated with unemployment, number of psychotic episodes, side-effects of medication, and life events score. The present findings suggest that a severe illness (no. psychotic episodes, unemployment), psychological stress and inappropriate treatment (side-effects of medicines) may be causally related to relapse in schizophrenia. However, the possibility that these variables may be caused by relapse or may be explained by a common underlying variable needs to be assessed prospectively.     

Needs-based cognitive-behavioural family intervention for patients suffering from schizophrenia: 5-year follow-up of a randomized controlled effectiveness trial

Objective: To determine whether a 24‐week, needs‐based cognitive‐behaviourally oriented family intervention for patients suffering from schizophrenia led to improved relapse profiles over a 5‐year follow‐up period. Method: The case notes of 60 patients who had participated in a randomized, controlled effectiveness trial were examined to determine relapse rates over a 5‐year period. Results: Patients were less likely to relapse over the 5‐year follow‐up when they received the needs‐based family intervention, especially in relation to exacerbations of symptoms not requiring inpatient admissions: 86.7% of control participants relapsed compared with 53.3% (P = 0.01). Survival analysis indicated that the relapse risk was 2.5 times higher for patients receiving routine care, compared with those receiving family intervention. A similar trend was observed for the final 4 years of follow‐up. Conclusion: The present study provides some tentative support for the long‐term effectiveness of family‐based interventions for the management of schizophrenia in general mental health services.     

The cost of relapse in patients with schizophrenia in the European SOHO (Schizophrenia Outpatient Health Outcomes) study

Background

Relapse in schizophrenia is one of the greatest burdens of the illness.

Aims

To estimate the costs associated with relapse in a pan-European naturalistic setting.

Method

The SOHO study is a 3-year, prospective, observational study of 10,972 outpatients with schizophrenia across 10 European countries. The cost of resource use (inpatient stay, day care, psychiatrist visits and medication) for those who ever relapsed in three years was compared to those who never relapsed. One-year costs for both groups were also compared for a more stringent comparison. The analyses were adjusted for patient characteristics and took account of non-normality of the cost data by using a log-link function. UK unit costs were applied to resource use. The analysis was repeated after multiple imputation for missing data.

Results

Costs incurred by patients who ever relapsed (£14,055) during three years were almost double to those incurred by patients who never relapsed (£7417). 61% of the cost difference was accounted for by hospital stay. The impact of relapse was even greater in the 1-year cost comparison. Results from the additional analysis with imputed missing data remained largely consistent.

Conclusions

Our findings confirm the significant economic burden of relapse, and show such costs were mainly due to hospital stay. Nevertheless, the use of UK unit costs requires caution when interpreting this costing in the context of a specific country, as resource use and their associated costs will differ by country.     

Electroconvulsive therapy for the treatment of clozapine nonresponders suffering from schizophrenia

Objective This open label study describes the efficacy of electroconvulsive therapy (ECT) as adjunctive treatment in clozapine nonresponders suffering from schizophrenia. Method The results of clozapine and ECT treatment in 11 clozapine nonresponders suffering from schizophrenia are reported in terms of remission and relapse. Results Eight patients had a remission with this combination treatment. After remission of symptoms five patients had a relapse. Three of the five patients who relapsed had a second successful ECT course and remained well with maintenance ECT and clozapine. No evidence for adverse effects was found. Conclusion Adjunctive ECT can be efficacious in clozapine nonresponders suffering from schizophrenia.