精神分裂症患者攻击行为的危险因素与护理对策

目的 探讨精神分裂症患者攻击行为的危险因素及护理对策。方法 采用对照分析法，对50例有攻击行为的精神分裂症患者和50例无攻击行为的精神分裂症患者的相关资料进行分析和显著性检验。结果 两组精神分裂症病人在BPRS和临床特征上存在显著差异，提示BPRS的幻觉、敌意猜疑因子分和临床特征中既往有攻击史、易激惹、不合作、治疗依从性差及医务人员的强制手段是精神分裂症患者攻击行为的危险因素。结论 及早对精神分裂症攻击行为患者实施心理干预及健康指导，可以将攻击行为减少到最低限度。     

复退军人罹患精神分裂症的临床特征对照研究

目的：探讨复退军人患精神分裂症的临床特征。方法比较复退军人精神分裂症（265例）与非复退军人精神分裂症（287例）的一般临床资料、生活事件强度、诊断类型、BPRS评分治疗效果及社会支持系统。结果两组患者在一般临床资料、遗传史、病前性格、诊断类型及总体疗效方面基本相似，但BPRS总分相近因子分有差异。复退患者病程较长、生活事件强度较高、社会支持系统相对较差。结论复退军人患精神分裂症者面临一定的生活、经济压力，社会支持系统相对较差，值得有关方面重视。     

晚发与早发精神分裂症临床症状的比较研究

目的 了解晚发与早发精神分裂症临床症状之间的差异。方法 对不同年龄初发精神分裂症患者进行BPRS、SANS、SAPS、HAMA和HAMD量表评定,然后作临床症状的比较。结果 晚发组在BPRS缺乏活力因子分,SANS总分,HAMD迟缓、绝望感因子分低于早发组,BPRS敌对猜疑因子分高于早发组(P<0.05)。晚发组的以被害妄想、牵连观念、情绪不稳较多见,而被洞悉感、思维形式障碍、情感迟钝、意志缺乏较少。结论 晚发精神分裂症与早发精神分裂症的临床症状有所不同,提示晚发精神分裂症可以作为精神分裂症的一个亚型。     

精神分裂症患者认知功能与精神症状相关性研究

目的：探讨精神分裂症患者认知功能与精神症状的相关性。方法：对40例精神分裂症患者于治疗前、治疗12周末分别进行韦氏成人智力量表（WAIS-R）、韦氏记忆量表（WMS）、H—R神经心理成套测验（HRB）中的连线测验A、威斯康星卡片分类测验（WCST）及言语流利性测验及简明精神病评定量表（BPRS）评定。结果：治疗前焦虑抑郁因子分与总记忆商数（MQ）分显著相关,迟滞因子分与WCST完成类别数、智力显著相关;治疗12周末焦虑抑郁因子分与总智商（IQ）显著相关,迟滞因子分与WCST持续反应数、言语IQ、操作IQ显著相关,猜疑因子分与WCST持续反应数显著相关。结论：精神分裂症患者部分认知功能与精神症状显著相关。     

影响慢性精神分裂症患者认知功能的多因素分析

目的：探讨慢性精神分裂症病人认知功能的影响因素。方法：采用简明智能评定量表、简明精神病评定量表（BPRS）、自知力与治疗态度问卷（ITAQ）对80例长期住院的慢性精神分裂症病人进行评定，以简明智能评定量表的总分（智能百分比）及其6个因子变量，以能够反映病人病情的BPRS总分、BPRS的5个因子分、ITAQ总分以及病程、Andrensens分型、年龄、首发年龄、受教育年限、家族史等因素为自变量，进行因素分析。结果：显示认知功能和总病情、Andrensens分型和受教育年限等有关，而与病程及其它因素无明显相关，结论：精神分裂症的认知功能障碍与病情和阴性症状密切相关，但不随病程而加重，提示认知功能障碍是独立于阴性症状以外的第三个症状成分。     

首发精神分裂症病人的抑郁症状

目的探讨首发精神分裂症病人抑郁症状的发生率、特征及相关因素。方法于入院、治疗3、6、9、12月时用汉密尔顿抑郁量表(HAMD)、简明精神病评定量表(BPRS)、阴性症状量表中文版(SANS-CV)、临床总体印象量表(CGI)及功能总体评定量表(GAF)对164例首发精神分裂症患者进行评定。结果急性期首发精神分裂症病人轻度或以上程度抑郁症状的发生率为71%,但在缓解期降至12%。急性期突出的抑郁表现为认知障碍与迟缓(因子分各占HAMD总分的35%和29%)。抑郁症状随着精神病性症状的缓解而减轻,与性别、发病年龄、受教育时间、病程及前驱期长短无关。HAMD总分在急性期仅与BPRS的焦虑抑郁因子分有关,但在缓解期与阴阳性症状、临床总体印象以及总体功能均有密切的相关性;急性期以及治疗3个月时的抑郁症状与随后的阴阳性症状、总体功能的变化无关。结论首发精神分裂症急性期的抑郁症状可能是一个独立的症状群,抑郁程度不能作为预测首发精神分裂症病人预后的指标。     

精神分裂症患者攻击行为的相关因素对照研究

目的　通过对住院精神分裂症有和无攻击行为患者资料的对照研究来探讨与精神分裂症患者攻击行为相关的因素。方法　收集住院精神分裂症患者的人口学和住院资料、BPRS、WCST、T3、T4、TSH等因子 ,用MOAS评定攻击行为并在有和无攻击行为组间分别进行显著性检验 ,然后通过回归分析 ,考察影响精神分裂症病人攻击行为的相关因素。结果　两组精神分裂症病人在BPRS、TSH、WCST等因子上存在显著差异 ,其中BPRS的敌意猜疑因子、诊断分型、TSH及WCST的持续错误数能够用于预测精神分裂症病人的攻击行为。结论　精神分裂症患者的攻击行为可能有精神病理学、神经心理学和神经内分泌学基础。     

精神分裂症症状严重度预测维思通的6周疗效

目的通过精神分裂症疗前症状的严重度预测维思通治疗6周时的疗效。方法对27例服用维思通(3.9±1.0)mg/d的精神分裂症患者在治疗前和治疗6周末分别评定简明精神病量表(BPRS)。结果疗前BPRS总分与6周BPRS总分减分值相关(r=0.526,P<0.05)。同样,焦虑忧郁、缺乏活力、思维障碍、激活性和敌对猜疑因子的疗前分分别与6周减分值有正相关(r分别为0.965、0.525,0.604、0.715和0.882,P<0.05)。结论疗前总症状或各症状群越重,维思通治疗6周后的相关症状改善越明显,基线各因子的预测效率以焦虑忧郁和敌对猜疑为最高,激活性为中度,而思维障碍和缺乏活力为低度。     

精神分裂症血清肌酸磷酸激酶活性研究

目的：探讨精神分裂症患者血清肌酸磷酸激酶（CPK）活性与病情的关系。方法：对195例精神分裂症患者于治疗前、治疗4和8周末分别进行CPK检测，同时以简明精神病量表（BPRS）、阴性症状量表（SANS）和阳性症状量表（SAPS）评定其情严重度。选取同期本地区健康体检者69名为对照组。结果：精神分裂症在发病期的CPK活性极显著高于对照组，治疗后显著下降，4周末已降至正常范围；在发病期的CPK值与BPRS总分、思维障碍因子分、激活性因子分和SAPS因子分呈显著正相关，好转后相关性降低，至8周末已无相关性；病例组CPK变化值与BPRS总分减分值、激活性因子的减分值和SAPS总分的减分值呈显著正相关。结论：精神分裂症患者在发病期的CPK活性显著升高，与病情关系密切，与阳性症状相平等，这可能是精神分裂症的神经－免疫、代谢相互作用的结果。     

首发精神分裂症症状严重度预测利培酮的6周疗效

目的通过对首发精神分裂症患者治疗前症状的严重度预测利培酮治疗6周后的疗效。方法对62例服用利培酮（3．9±0．9mg／d）的首发精神分裂症患者在治疗前和治疗6周末分别采用简明精神病量表（BPRS）评定。结果疗前BPRS总分与6周BPRS减分值相关（r=0．786,P〈0．01）;焦虑忧郁、缺乏活力、思维障碍、激活性和敌对因子的疗前分,分别与6周减分值呈正相关（r=0．928、0．425、0．645、0．939、0．684,P〈0．01）。结论疗前总症状或各症状群越重,利堵酮治疗6周后的相关症状改善越显著。     

Oxidative mechanisms in schizophrenia and their relationship with illness subtype and symptom profile

Aim:  The aim of the present study was to investigate the differences in the antioxidant–oxidant balance (AO-OB) between schizophrenic patients and healthy individuals and to explore the relationship of AO-OB with illness subtypes and symptom profiles.
Methods:  After a 15-day drug-free period, schizophrenia patients ( n  = 50) in a clinical sample, and age- and sex-matched healthy subjects ( n  = 49) were enrolled. Total antioxidant potentials (TAOP) and total peroxide levels (TPEROX) of all participants were measured and the oxidative stress index (OSI) was calculated. The assessment included structured measurements, including the Positive and Negative Syndrome Scale (PANSS), and the Brief Psychiatric Rating Scale (BPRS).
Results:  TAOP had a significant positive correlation with age at onset of schizophrenia ( P  = 0.013), a negative correlation with the PANSS negative subscale scores ( P  = 0.008), a negative correlation with the PANSS total scores ( P  < 0.001), and a significant negative correlation with BPRS scores ( P  = 0.001). OSI had a significant negative correlation with age at onset ( P  = 0.046) and a significant positive correlation with PANSS negative subscale ( P  = 0.015). A multiple regression model indicated a significant linear combination of age, gender, duration of illness, subtype of schizophrenia, and PANSS scores, in which only the subtype of schizophrenia made a statistically significant contribution to predicting mean OSI ( F [5,35] = 2.44, P  = 0.04).
Conclusion:  Several parameters in the pathogenesis of schizophrenia, such as age of onset, level of negative symptoms, and subtype of illness, but not the presence of the illness itself, are associated with the level of oxidative stress.     

Does substance use disorder affect clinical expression in first-hospitalization patients with schizophrenia? Analysis of a prospective cohort

Although several papers reported a wide range of negative outcomes among patients with both schizophrenia and Substance Use Disorder (SUD), only a few studies evaluated the impact of SUD on psychopathology and thus on the length of first-hospitalization. The aim of the present study was to compare clinical expression of first-episode of schizophrenia between inpatients with and without SUD, giving close attention to the length of stay. One hundred and thirty inpatients at first-episode of schizophrenia were assigned to either SUD or not SUD group depending on SUD diagnosis and were assessed through BPRS at admission, during hospitalization and at discharge. Cross-sectional and longitudinal statistical analysis were performed to investigate differences between groups and also a linear regression was used to evaluate relationship between length of stay and BPRS scores. SUD group showed more disorganization at admission, less marked improvement of symptoms (disorganization, thought disturbance, anergia), and longer hospital stay than not SUD group. Moreover BPRS total score during hospitalization was a significant positive predictor for length of stay. Taken together, these findings suggest that SUD patients have a more severe and drug-resistant expression of schizophrenia, hence, they need longer treatment to achieve the overall symptoms improvement required for discharge.     

The efficacy of the D2 and 5-HT2 antagonist risperidone (R 64,766) in the treatment of chronic psychosis. An open dose-finding study

After a wash-out period of 1 week, 20 patients suffering from schizophrenia were treated for 4 weeks in an open dose-finding study with a new serotonin-dopamine antagonist risperidone. All patients completed the trial. The mean daily dose of risperidone was 4.6 mg (range 2-10 mg) at completion. Risperiodone had a rapid onset of action: a highly significant decrease of the total BPRS score (Brief Psychiatric Rating Scale) was already noticed at the end of the second week. This decrease was found in all BPRS factors after 4 weeks. In spite of the withdrawal of antiparkinson medication at selection, a clear decrease of EPS (extrapyramidal symptoms), assessed on the Simpson and Angus Scale, was observed. The Global Therapeutic Impression agreed to the BPRS scores, showing a highly significant improvement after 2 weeks of treatment. Risperidone was very well tolerated, only mild side effects were reported. Vital signs, electrocardiographic parameters and laboratory values remained normal during the trial. This study indicates that risperidone can be an effective and well-tolerated alternative in the treatment of chronic schizophrenia, combining an antipsychotic activity, a beneficial effect on anergia and anxiety depression and a low EPS-inducing profile.     

Evidence for association of hyperprolinemia with schizophrenia and a measure of clinical outcome

There are multiple genetic links between schizophrenia and a deficit of proline dehydrogenase (PRODH) enzyme activity. However, reports testing for an association of schizophrenia with the resulting proline elevation have been conflicting. The objectives of this study were to investigate whether hyperprolinemia is associated with schizophrenia, and to measure the relationship between plasma proline, and clinical features and symptoms of schizophrenia. We performed a cross-sectional case-control study, comparing fasting plasma proline in 90 control subjects and 64 schizophrenic patients and testing for association of mild to moderate hyperprolinemia with schizophrenia. As secondary analyses, the relationship between hyperprolinemia and five measures of clinical onset, symptoms and outcome were investigated. Patients had significantly higher plasma proline than matched controls (p<0.0001), and categorical analysis of gender adjusted hyperprolinemia showed a significant association with schizophrenia (OR 6.15, p=0.0003). Hyperprolinemic patients were significantly older at their first hospitalization (p=0.015 following correction for multiple testing). While plasma proline level was not related to total, positive or negative symptoms, hyperprolinemic status had a significant effect on length of hospital stay (p=0.005), following adjustment for race, BPRS score, and cross-sectional time from admission to proline measurement. Mild to moderate hyperprolinemia is a significant risk factor for schizophrenia, and may represent an intermediate phenotype in the disease. Hyperprolinemic patients have a significantly later age of first psychiatric hospitalization, suggestive of later onset, and hospital stays 46% longer than non-hyperprolinemic subjects. These findings have implications in the etiology of schizophrenia, and for the clinical management of these patients.     

Short-term effect of ECT in middle-aged and elderly patients with intractable catatonic schizophrenia

BACKGROUND AND OBJECTIVE: The management of middle-aged and elderly patients with catatonic schizophrenia has long been a major problem in clinical geriatric psychiatry. Most cases are intractable because of medication resistance, medication intolerance, or severe medical conditions. Electroconvulsive therapy (ECT) is recognized as one of the most efficacious therapies for catatonic schizophrenia. Thus, we conducted a prospective study of the short-term effect of acute ECT on middle-aged and elderly patients with intractable catatonic schizophrenia. MATERIALS AND METHODS: Subjects were nine consecutive patients older than 45 years who had fulfilled the DSM-IV criteria for catatonic-type schizophrenia and had been referred for first-time acute ECT after other treatments had failed. The patients were treated at Tohoku University Hospital between January 1998 and March 2002. We evaluated the clinical response of these patients to acute ECT by means of the brief psychiatric rating scale (BPRS). We also evaluated adverse effects of acute ECT. RESULTS: The response rate was 100%. The total BPRS score was improved in all nine subjects at the end of the ECT course and 1 week after the final session in comparison with the total pre-ECT BPRS score (11.9 +/- 7.5 and 9.3 +/- 9.2 versus 57.1 +/- 13.1, respectively, p = 0.008, p = 0.008). The total Global Assessment of Functioning score was also improved significantly (from 10.8 +/- 9.4 just before ECT to 61.6 +/- 18.9 1 week after ECT, p = 0.008). Guy's five factors (thought disturbance, activation, anxiety-depression, hostility-suspiciousness, and anergia) improved significantly (p = 0.008, p = 0.008, p = 0.018, p = 0.012, p = 0.008, respectively). One patient showed supraventricular premature contractions (SVPCs) during an ECT seizure. After some ECT sessions, three patients exhibited mild to moderate delirium that disappeared within 3 days. However, no patient experienced a severe cognitive or physical adverse effect during the course of ECT. CONCLUSIONS: Acute ECT has a good short-term effect on middle-aged and elderly patients with intractable catatonic schizophrenia and appears to be safe. Our results indicate that systematic studies on a large scale are warranted for further investigation of the efficacy and safety of acute ECT for treating middle-aged and elderly patients with catatonic schizophrenia.     

Evaluation of Mini Mental State Examination and Brief Psychiatric Rating Scale on aged schizophrenic patients

Abstract  Mini Mental State Examination (MMSE), Brief Psychiatric Rating Scale (BPRS) and subscales of the BPRS were performed on 73 elderly inpatients (mean age: 67.9 years; standard deviation: 7.2; range: 60–89) diagnosed with DSM-III-R chronic schizophrenia. Forty of the subjects were men and 33 were women. A significant negative correlation was observed between MMSE and the age, factor negative, factor depressive, and total score of BPRS. We believe, however, that it is relatively sufficient to screen for demented illness of schizophrenics using MMSE when considering the age and the psychiatric symptoms (especially negative or depressive symptoms). Forty-eight (66%) of the 73 patients were categorized as 'demented' by MMSE. These results suggest that the aged inpatients with schizophrenia in a hospital showed certain kinds of cognitive deficits (including senile dementia) more frequently than the general population.     

Smoking in chronic schizophrenic inpatients in taiwan

OBJECTIVE: This study investigated the prevalence of smoking and its association with the clinical characteristics of Chinese inpatients with chronic schizophrenia. METHOD: Schizophrenic patients hospitalized in chronic wards were assessed using Brief Psychiatric Rating Scale (BPRS), Abnormal Involuntary Movements Scale (AIMS) and Folstein Mini-Mental Status Examination (MMSE) testing. RESULTS: Of 257 patients, 105 smoked and 4 had ceased. Males exhibited a higher prevalence of smoking than females (p < 0.001). Smoking was not significantly associated with age at onset (AAO), chlorpromazine equivalents, MMSE, AIMS, BPRS positive symptom subscale, BPRS negative symptom subscale or total BPRS scores. Smokers had higher BPRS general subscales. CONCLUSION: Compared to the general population, smoking prevalence was slightly higher in schizophrenic males, double in schizophrenic females, but no difference in refractory schizophrenic clozapine users. Smoking did not affect patient AAO or daily antipsychotic dose. Patients with a higher BPRS general subscale may smoke to relieve affective symptoms.