Needs for care of chronic schizophrenic patients in long-term community treatment

Abstract.Background: Specific problems of long-term community care of chronic schizophrenic patients are an under-researched area interesting for the provision of regional mental health care.Methods: This study focuses on a 4 1/2-year prospective assessment of normative needs for care in a cohort (initially N = 115) living in the Dresden care region (Germany). At six time-points, normative needs for care were assessed with the Needs for Care Assessment (NFCAS).Results: The total number of problems did not change significantly over the study period. The average number of met needs was lower at the longer-term follow-up assessments,due particularly to a decrease in the social section. This trend is also demonstrated for the average number of unmet needs. In contrast, the mean number of unmeetable needs increased. Consistently, 70–80% of the patients exhibit problems in positive psychotic and negative symptoms, household affairs and recreational activities. Communication, occupation and recreational activities constitute a trio of social needs not met for nearly one-third of the patients disabled in these respects. Logistic analyses of regression could not identify a predictive model for the total needs development within the 4 1/2-year community treatment.Conclusion: The rather stable pattern of needs for care seems to define clear long-lasting tasks for community mental health services. For chronic schizophrenic patients, services should especially focus on social skills training and psychoeducational approaches. Due to a wide range of possible factors of influence, however, planning long-term context-dependent processes of care in the community lacks a clear evidence base.     

酒精中毒和精神分裂症患者自杀行为的比较分析

对２９例酒精中毒和３４例精神分裂症（对照组）患者自杀行为和病态心理动因进行了对照分析。结果酒精中毒患者中自杀行为发生率２２．１％，较对照组１６．７％高；两组精神症状比较以听幻觉，思维散漫和易激惹有显著差异（Ｐ＜０．０５）；幻觉是酒精中毒患者出现自杀行为的主要原因。     

阿立哌唑治疗抗精神病药所致闭经的精神分裂症对照研究

目的:探讨阿立哌唑对抗精神病药所致闭经的精神分裂症患者的影响.方法:69例抗精神病药引起闭经的女性精神分裂症患者,随机分为A组(单用阿立哌唑治疗)34例和B组(用其他抗精神病药联合中药血府逐瘀汤治疗)35例,观察疗程3个月.于治疗前、治疗后1、2、3个月测定血清催乳素浓度,并评定闭经的疗效.结果:治疗后两组血清催乳素浓...     

Costs and benefits of day treatment with community care for schizophrenic patients

The feasibility of day treatment with community care for schizophrenic patients was tested by means of a longitudinal randomized experiment with 34 experimentals and 16 controls: 38 percent could be treated satisfactorily in a day program that included a very active ambulatory service. The new approach did not improve prognosis with respect to psychiatric symptomatology, social role disabilities, or number of readmissions during the first year of followup. Total cost of treatment was less for day-treatment patients than for ordinary clinical patients.     

A controlled dose comparison of haloperidol in newly admitted schizophrenic patients

Eighty newly admitted or readmitted men with DSM-III schizophrenia were assigned to receive 5, 10, or 20 mg/d of haloperidol for 4 weeks. Staff were not "blind" to dose. By Clinical Global Impression Scale ratings, the 20-mg dose appeared to be superior to both the 5- and 10-mg doses for the first 2 weeks of treatment but not thereafter. On the Brief Psychiatric Rating Scale Schizophrenia factor, the 20-mg dose was superior to the 5-mg dose throughout the trial and tended to be marginally superior to the 10-mg dose after the first 2 weeks of treatment. By the second week of treatment, however, the group receiving the 20-mg dose deteriorated significantly with regard to Brief Psychiatric Rating Scale ratings of Withdrawal-Retardation (blunted affect, motor retardation, and emotional withdrawal) as well as akinesia and akathisia ratings. Furthermore, 35% of patients given 20 mg/d of haloperidol insisted on leaving the hospital against medical advice vs only 4% of those given 5 or 10 mg/d of haloperidol. A 20-mg/d dose of haloperidol, therefore, may have substantial "psychotoxic" effects by the second week of treatment.     

社区精神分裂症患者服药依从性初步探讨

对３４８例社区精神分裂症患者服药依从性的相关因素进行分析。发现依从性好坏与患者目前病情有显著关系。依从性好的稳定率、缓解率明显高于差的；依从性好的定期规律随诊率明显高于依从性差的。     

哌泊噻嗪、氟哌啶醇癸酸酯与氟奋乃静癸酸酯治疗精神分裂症的对照研究

建桐翁正【摘要】目的验证和比较哌泊噻嗪、氟哌啶醇癸酸酯、氟奋乃静癸酸酯三种长效抗精神病制剂对精神分裂症的疗效及副反应。方法采用多中心、开放随机对照研究，以简明精神病评定量表（ＢＰＲＳ）、阳性症状评定量表（ＳＡＰＳ）、阴性症状评定量表（ＳＡＮＳ）、临床疗效总评量表（ＣＧＩ）和副反应量表（ＴＥＳＳ）、锥体外系副反应量表（ＲＳＥＳＥ）综合评定。结果治疗后哌泊噻嗪组患者的ＣＧＩＳＩ与ＣＧＩＧＩ分值和ＳＡＮＳ量表总分均低于其它两组，差异均有显著性（Ｐ＜０．０５），而ＢＰＲＳ和ＳＡＰＳ量表总分治疗结束时三组间差异无显著性（Ｐ＞０．０５）。ＴＥＳＳ总分和ＲＳＥＳＥ总分在整个治疗过程中均以氟奋乃静癸酸酯组最高，哌泊噻嗪组最低。结论三组中以哌泊噻嗪对精神分裂症的疗效较好，对阴性症状的改善优于氟哌啶醇癸酸酯组和氟奋乃静癸酸酯组，对阳性症状的疗效近似。哌泊噻嗪组副反应较少，安全度较好     

躁狂症与精神分裂症妄想特征比较

目的：比较躁狂症与精神分裂症妄想特征及病理机制的差异。方法：用自编妄想特征调查表对躁狂症和精神分裂症患者各56例的妄想特征进行比较。结果：精神分裂症最多见的被害、关系妄想；躁狂症患者最多见夸大妄想，其次为被害、关系妄想。两者的持续时间，隐蔽性、协调性、稳定性以及伴随症状均有差异。结论：精神分裂症与躁狂症患者妄想特征及病理心理机制可能不同。     

社区慢性精神分裂症患者的需求评估

目的 了解社区慢性精神分裂症患者的需求状况,分析有关影响因素。方法 120例符合CCDM—2—R精神分裂症诊断标准的患者完成调查。依据SDSS总分划分轻残组、中疾组、重残组。评价工具:1.Camerwell需求评价量表(CAN);2.生活质量评定量表(QOLS);3.阳性阴性症状评定量表(PANSS)。结果 CAN需求栏目评价结果:三组间家庭照料、日常生活、解决精神病症状、了解疾病和治疗信息、社会接触和社会救助具显著差异(p<0.05)。中残组和重残组得到家庭帮助显著多于社会帮助(t=4.46,3.54,p<0.05)。轻残组与中残组CAN需求总分与QOLS总分里显著相关(p<0.05)。多元逐步回归分析结果显示,CAN各个因子的主要影响因素为精神症状严重度、病程、工作状况以及照料者身份。结论 不同病情严重度的病人需求内容所占的比重也有所不同,主要涉及家庭日常生活、疾病的治疗以及社会性需求等方面,源于家庭的帮助显著多于社会帮助。需求的影响因素是多方面的。     

A comparison of verbal fluency tasks in schizophrenic patients and normal controls

Previous studies have reported significant impairment on verbal fluency tasks (semantic and letter) among schizophrenic subjects. However, the possibility of specific categorical deficits has not been adequately investigated. Nor have the effects of task duration, the stability between testing sessions, and the relationship between intelligence and performance on fluency been thoroughly studied. We performed a series of 3 min fluency tasks (semantic/syntactic and letter) to determine whether duration specific or category-specific differences exist between schizophrenic subjects and normal controls. Each subject was tested at three different times as a means of estimating word pool and assessing the stability of fluency output. Subjects were asked to generate exemplars from each of four semantic/syntactic categories (animals, tools, common nouns and verbs) and three letters (G, E and T). Data from 13 schizophrenic subjects and 15 sex-, age- and pre-morbid-IQ-matched control subjects revealed that patients' overall performance on both the semantic and letter fluency tasks was impaired. While differential impairment on specific semantic categories was noted between groups, no differential effects relating to task duration or testing session were present. Further, by comparing the number of novel words produced in the three testing sessions, we found the groups to be equivalent, a finding we take to suggest that schizophrenic patients' lexicon is intact. Covarying current IQ eliminated the group difference robustly for letter fluency, while only marginally for semantic fluency. Our data revealed the presence of impairment in semantic and letter fluency tasks in schizophrenic patients consistent with previous reports, and also that patients were differentially impaired on semantic categories.     

A double-blind comparison study between penfluridol and perphenazine in acute schizophrenic patients

Penfluridol och perfenazin var helt jämbördiga med avseende på klinisk effekt vid behandling av schizofrena patienter i denna studie från Säters sjukhus. Penfluridol gav dock något mer biverkningar, konstaterar författaren, överläkare Kurt L. Eklund.     

Psychopharmacological treatment of aggression in schizophrenic patients

Aggressive behavior is frequently observed in schizophrenic patients. More than 50 % of all psychiatric patients and 10 % of schizophrenic patients show aggressive symptoms varying from threatening behavior and agitation to assault. The pharmacological treatment of acute, persisting and repetitive aggression is a serious problem for other patients and staff members. Not only is violent behavior from mentally ill patients the most detrimental factor in their stigmatization, aggression is also a considerable direct source of danger for the patients themselves. Based on rather limited evidence, a wide variety of medications for the pharmacological treatment of aggression has been recommended: typical and atypical antipsychotics, benzodiazepines, mood stabilizers, beta-blockers and selective serotonin reuptake inhibitors (SSRIs). Most clinical information on treating aggression has been collected for atypical neuroleptics, particularly for clozapine. Several retrospective and open studies indicate its efficacy. Treatment duration of 6 months is recommended to induce a stable reduction of physical and verbal aggression. Severe side effects have very rarely been seen. At the moment, clozapine seems to be the first choice in aggression treatment. Within the last few years, about 10 articles were published showing that this is the most effective antiaggressive agent in the treatment of aggression and agitation in psychiatric patients, independent of psychiatric diagnosis. However, clozapine, like all the other substances used, does not have an established indication for the treatment of aggressive symptoms. Noncompliance with medication makes it difficult to choose the right preparation for the medication: tablets, liquids, intramuscular injections and readily soluble "FDDFs" are available. Ethical, juridical and methodological problems prevent controlled studies from establishing a reference in the treatment of aggression in mentally ill patients. This review summarizes the current discussion and publications on the pharmacological treatment of aggression in schizophrenic patients of the last 20 years. In addition, we will briefly present studies and case reports concerning the treatment of aggression in other psychiatric patients.     

501例社区中精神分裂症患者现状分析

对列为社区康复对象的５０１例精神分裂患者现状调查。发现此类病人病情较重。病程长，迁延不愈，反复发作，精感衰退，治疗状况差，家庭经济困难，是精神疾病社区康复的重点对象。     

A comparison of assertive community treatment and intensive case management for patients in rural areas

OBJECTIVE: This article reviews the evidence for the effectiveness of community-based services for rural areas, specifically assertive community treatment and intensive case management. Service delivery to persons with severe mental illness in rural areas is challenged by low population densities, limited services, and shortages of professionals. METHODS: A comprehensive literature search identified six studies of rural assertive community treatment, only two of which were controlled studies, and four rural intensive case management studies, only one of which was a controlled study. Assertive community treatment would seem ideally suited to areas lacking services because of its self-contained multidisciplinary treatment team approach. However, rural programs have been forced to make several adaptations to the assertive community treatment model, including smaller teams, less comprehensive staff, and less intensive services. There is no published evidence that these adaptations are able to produce the same results as full-fidelity teams. Some believe that intensive case management may be an alternative to assertive community treatment in rural settings because intensive case management emphasizes individual caseloads, fewer staff, less intensive contacts, and brokered services. CONCLUSIONS: The evidence suggests that intensive case management programs are effective only in community settings where there is an ample supply of treatment and support services. To build the evidence base for the effectiveness of these models, much more attention needs to be focused on evaluating the current wave of assertive community treatment and intensive case management dissemination in rural areas.