流浪与非流浪精神分裂症患者的家庭环境比较（英文）

背景:流浪行为逐渐成为中国严重精神疾病患者的一个重要问题。目的:发现在精神分裂症患者中与流浪行为相关的家庭特征因素。方法:本研究被试人员都来自湖南省湘潭市,包括1856例具有流浪行为的精神分裂症患者(其定义为连续7天没有地方居住或无照顾者)和1728例无流浪行为的精神分裂症患者。所有被试人员在急性精神病性症状得到缓解后,自行填写中文版家庭环境量表(FamilyEnvironment Scale-Chinese Version,FES-CV)。结果:与无流浪行为的患者相比,有流浪行为的患者更为年长,并且更可能不是本地人(即从湘潭以外的地方来的),更可能是农村居民(相对于城市),更可能是临时工(相对于固定职业),多为已婚,以及教育程度偏低。本研究采用逻辑回归模型并控制人口学差异,发现流浪行为分别与FES-CV知识性、组织性、成功性和控制性分量表的较高评分独立相关,并分别与FES-CV凝聚力、道德宗教观、独立性、和娱乐性分量表的较低评分独立相关。结论:即使控制了社会人口学因素后,家庭环境的某些方面还是与中国精神分裂症患者的流浪行为相关,并需要进一步研究以确定可以减少高风险人群的流浪行为风险的干预措施。     

流浪儿童的心理健康状况及基于流浪原因的心理救助启示

随着经济的不断发展,流浪儿童的救助机构日益完善,越来越多的流浪儿童可以获得救助,但大部分救助机构的救助仍停留在让流浪儿童"回家"而忽视了他们的心理健康,这在一定程度上导致了流浪儿童的反复流浪,增加了社会的潜在危险性.而流浪儿童的心理健康状况与其流浪原因密切相关,以流浪儿童的心灵"回归"为出发点,基于文献分析,梳理了流浪...     

流浪精神病人的研究介绍

流浪者中精神疾病患病率高,关注度不够。本文就目前国内外流浪精神病人的流行病学、社会危害与救助等方面相关研究进展进行综述。     

流浪精神病人的研究介绍

流浪者中精神疾病患病率高,关注度不够。本文就目前国内外流浪精神病人的流行病学、社会危害与救助等方面相关研究进展进行综述。     

流浪精神分裂症患者临床特征研究

目的:比较流浪与非流浪精神分裂症患者的临床特征的差异。方法:对200例流浪精神分裂症患者(流浪组)和200例非流浪精神分裂症患者(非流浪组)临床特征及简明精神病评定量表(BPRS)进行比较分析。结果:流浪精神分裂症患者中伴躯体疾病和既往有精神病史患者显著性高于非流浪精神分裂症患者;流浪精神分裂症患者中BPRS总分、思维障碍、兴奋冲动、敌对猜疑显著性高于非流浪精神分裂症患者。结论:流浪精神分裂症患者的临床特征与非流浪精神病患者有明显差异。     

87例流浪精神障碍患者临床分析

目的：对比住院的流浪与非流浪精神障碍患者临床特点差异。方法：选择2006年住院的87例流浪精神障碍患者作为流浪者组，男52例，女35例；在同期入院的其他精神障碍患者中随机选取90例作为对照组，男59例，女31例；比较分析两组有关情况，并作护士用住院病人观察量表（NOSIE）与阳性与阴性症状量表（PANSS）评定。结果：两组在入院原因，出入院方式，诊断，住院时间，疗效，NOSIE和PANSS评分等方面均有显著差异。结论：流浪精神障碍患者精神症状较重，多伴发躯体疾病，阳性症状突出，生活自理能力低，疗效较差，医院负担重。     

住院的流浪精神疾病患者临床分析

<正>对柳州市2010~2012年2年中由警察送入院的流浪精神疾病患者人口学及临床资料分析如下。1对象和方法由柳州市"110"警察送入院流浪精神病患者共369例,均符合中国精神障碍分类与诊断标准第3版相关精神疾病诊断标准;对入组者采用自制"住院流浪精神病患者调查表"进行一般人口学资料调查及临床资料统计。     

流浪精神病患者合并躯体疾病调查

目的:调查流浪精神病患者合并躯体疾病的情况。方法:回顾性分析1 043例住院流浪精神病患者的临床资料。结果:入组的患者中69%流浪精神病患者伴有躯体疾病,以皮肤软组织损伤(38%)、传染病(25%)和营养不良(15%)为最多。男性患者皮肤软组织损伤、骨折、感染性疾病伴有率明显多于女性(χ2=51.92,P0.001;χ2=5.82,P=0.016;χ2=8.15,P=0.004);女性患者梅毒感染率明显高于男性(χ2=13.42,P0.001)。结论:流浪精神病患者普遍伴有躯体疾病,女性患者性病伴发率高,男性患者躯体损伤、感染性疾病伴发率高。     

294例救助流浪精神病人临床特征分析

南阳市精神病医院承担了南阳市流浪精神病人的救治工作,现将收治294例流浪精神病人的临床资料进行分析,为救助此类病人提供指导。1对象和方法1.1对象自2009-01—2012-10出院的救助流浪精神病人294例。1.2方法用自编的调查表进行回顾性调查分析,包括一般性资料、住院原因、出入院方式、精神疾病分类、用药情况     

流浪精神病者管理现状和建议

精神病流浪街头是很常见的现象,它不仅给当地的社会环境造成影响,而且也对社会治安、公共卫生等带来巨大威胁,所以受到各国政府和相关人士的广泛关注,我国早在50 年代初即开展了此工作,是世界上最早开展流浪精神病收容、管理的国家之一,与国外比较我国对此研究明显落后于发达国家,本文旨在对近几年来国内外对流浪精神病管理的现状和存在的问题等作简要综述。     

Conduct disorder behaviors, childhood family instability, and childhood abuse as predictors of severity of adult homelessness among American veterans

Purpose

Despite US federal efforts to end and prevent homelessness among veterans, there has been limited examination of pre-military factors like childhood problems, associated with adult homelessness. This study examined childhood problems among homeless veterans and its relation to severity of homelessness and outcomes in supported housing.

Methods

Using data from 1,161 homeless veterans at 19 sites enrolled in the Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program, three types of childhood problems were examined: conduct disorder behaviors, family instability, and childhood abuse. Multiple regressions were conducted to examine the association between childhood problems and severity of homelessness before supported housing, and childhood problems and outcomes after supported housing.

Results

About one-third reported conduct disorder behaviors, over half reported family instability, and 40 % reported childhood abuse. Greater childhood problems were found in this sample compared to published samples of non-homeless veterans. Conduct disorder behaviors, family instability, and childhood abuse were each weakly associated with lifetime homeless episodes. One year after enrollment in the HUD-VASH program, past conduct disorder behaviors and family instability were not predictive of outcomes, except childhood abuse was related to less social support and lower quality of life.

Conclusions

These findings demonstrate not only the potential impact of childhood abuse on social relationships and quality of life in adulthood, but also the resilience of homeless veterans from adverse childhoods to be successfully housed in a supported housing program.     

What differentiates homeless persons who died by suicide from other suicides in Australia? A comparative analysis using a unique mortality register

Purpose

To study the incidence of suicide by homeless persons over a 20-year period, and identify demographic and clinical characteristics that distinguish these cases from those in non-homeless persons.

Methods

A comparative analysis of homeless and non-homeless persons who died by suicide between 1990 and 2009 in Queensland, Australia. Ninety-two persons (82 males and 10 females) were identified from the Queensland Suicide Register as being homeless at the time of death. Suicide rates were calculated for the second decade only due to the lack of population numbers of homeless persons in the first decade.

Results

Homeless persons had almost twice higher suicide rate than non-homeless counterparts. They were more often male, of young age, single/never married, non-Indigenous, unemployed, had at least one physical illness or other stressful life event prior to death, had drug and alcohol abuse problems, and also were more likely to have evidence for an untreated mental illness. Regression analysis showed that being unemployed, having a history of legal problems and not being diagnosed with mental illness were strongly associated with suicide among homeless persons.

Conclusions

This study is the first in Australia, and the second study internationally, to examine the characteristics of homeless people who died by suicide. Although based on a relatively small sample, the present work nonetheless carries practical implications for the development of targeted suicide prevention strategies in this peculiar population of individuals.     

Association of schizophrenia with the rs821633 polymorphism in the DISC1 gene among Han Chinese

Background

Previous studies report that various single nucleotide polymorphisms (SNP) in the Disrupted-in Schizophrenia 1 (DISC1) gene are closely associated with schizophrenia, but there are no studies that assess the relationship of age of onset of schizophrenia with these SNPs.

Objective

Investigate the relationship between the rs821633 SNP in the DISC1 gene and the occurrence and age of onset of schizophrenia in Han Chinese.

Methods

We used the TaqMan genotyping technology to examine the rs821633 SNP in the DISC1 gene among 315 individuals who developed schizophrenia prior to 19 years of age (‘early-onset’), 407 individuals who developed schizophrenia when 19 years of age or older (‘late-onset’), and 482 healthy controls. We used survival analyses to investigate the relationship between the rs821633(C) risk allele and the age of onset of schizophrenia.

Results

Compared to the prevalence in healthy controls, the prevalence of the C/C genotype of rs821633 and of the C allele in rs821633 were significantly greater in individuals with early-onset schizophrenia (X²=7.17, df=1, p=0.007; X²=7.20, df=2, p=0.032) and significantly greater in individuals with late-onset schizophrenia (X²=5.36, df=1, p=0.022; X²=6.58, df=2, p=0.041). However, there were no significant differences in the prevalence of the C/C genotype or the C allele between individuals with early-onset and late-onset schizophrenia. Kaplan-Meier survival analyses found no significant association between the rs821633(C) risk allele and age of onset in schizophrenia.

Conclusion

We confirm the association of polymorphism in the rs821633 SNP in the DISC1 gene with schizophrenia among Han Chinese, but we found no association between the rs821633(C) risk allele and the age of onset in individuals with schizophrenia.     

Correlations Between Brain Structure and Symptom Dimensions of Psychosis in Schizophrenia,Schizoaffective, and Psychotic Bipolar I Disorders

Introduction:

Structural alterations may correlate with symptom severity in psychotic disorders, but the existing literature on this issue is heterogeneous. In addition, it is not known how cortical thickness and cortical surface area correlate with symptom dimensions of psychosis.

Methods:

Subjects included 455 individuals with schizophrenia, schizoaffective, or bipolar I disorders. Data were obtained as part of the Bipolar Schizophrenia Network for Intermediate Phenotypes study. Diagnosis was made through the Structured Clinical Interview for DSM-IV. Positive and negative symptom subscales were assessed using the Positive and Negative Syndrome Scale. Structural brain measurements were extracted from T1-weight structural MRIs using FreeSurfer v5.1 and were correlated with symptom subscales using partial correlations. Exploratory factor analysis was also used to identify factors among those regions correlating with symptom subscales.

Results:

The positive symptom subscale correlated inversely with gray matter volume (GMV) and cortical thickness in frontal and temporal regions, whereas the negative symptom subscale correlated inversely with right frontal cortical surface area. Among regions correlating with the positive subscale, factor analysis identified four factors, including a temporal cortical thickness factor and frontal GMV factor. Among regions correlating with the negative subscale, factor analysis identified a frontal GMV-cortical surface area factor. There was no significant diagnosis by structure interactions with symptom severity.

Conclusions:

Structural measures correlate with positive and negative symptom severity in psychotic disorders. Cortical thickness demonstrated more associations with psychopathology than cortical surface area.Key words: positive, negative, cortical thickness, surface area, psychopathology, gray matter     

Housing First for People With Severe Mental Illness Who Are Homeless: A Review of the Research and Findings From the At Home–Chez soi Demonstration Project

Objective:

To provide a review of the extant research literature on Housing First (HF) for people with severe mental illness (SMI) who are homeless and to describe the findings of the recently completed At Home (AH)–Chez soi (CS) demonstration project. HF represents a paradigm shift in the delivery of community mental health services, whereby people with SMI who are homeless are supported through assertive community treatment or intensive case management to move into regular housing.

Method:

The AH–CS demonstration project entailed a randomized controlled trial conducted in 5 Canadian cities between 2009 and 2013. Mixed methods were used to examine the implementation of HF programs and participant outcomes, comparing 1158 people receiving HF to 990 people receiving standard care.

Results:

Initial research conducted in the United States shows HF to be a promising approach, yielding superior outcomes in helping people to rapidly exit homelessness and establish stable housing. Findings from the AH–CS demonstration project reveal that HF can be successfully adapted to different contexts and for different populations without losing its fidelity. People receiving HF achieved superior housing outcomes and showed more rapid improvements in community functioning and quality of life than those receiving treatment as usual.

Conclusions:

Knowledge translation efforts have been undertaken to disseminate the positive findings and lessons learned from the AH–CS project and to scale up the HF approach across Canada.     

Controlled trial of the effectiveness of community rehabilitation for patients with schizophrenia in Shanghai,China

Background

The ‘Sunshine Soul Park’ is a network of social welfare institutions that provides communitybased rehabilitation services for individuals with mental illness.

Aims

Assess the effectiveness of the rehabilitation services provided at the ‘Sunshine Soul Park’ on the psychotic symptoms and social functioning of individuals with schizophrenia and, based on these findings, provide a theoretical model of community-based rehabilitation.

Methods

Sixty individuals with schizophrenia in the Huangpu District of Shanghai volunteered for the rehabilitation training program provided at six ‘Sunshine Soul Park’ community centers that involves day treatment, medication monitoring, biweekly rehabilitation training, and other recreational, social, and intellectual activities. A matched control group was recruited from individuals with schizophrenia registered on the Huangpu District registry of the ‘Severe Mental Illness Prevention and Rehabilitation System’. All participants continued their medication without change for the full year of follow-up. Both groups were assessed at baseline, and 3, 6, and 12 months after enrollment using the Insight and Treatment Attitude Questionnaire (ITAQ), Social Disability Screening Schedule (SDSS), Generic Quality of Life Inventory-74 (GQOLI-74), and Positive and Negative Syndrome Scale (PANSS).

Results

In the intervention group the ITAQ, SDSS, GQOLI-74, and PANSS scores showed statistically significant improvement compared to baseline at each follow-up assessment. Moreover, the trend in improvement in the interventions group is significantly faster than that in the control group.

Conclusions

The ‘Sunshine Soul Park’ rehabilitation training program enhances patients’ knowledge about their disorder and improves their social functioning and quality of life. Further studies to assess methods for up-scaling this intervention to other areas of China are warranted.     

Relation between emotional face memory and social anhedonia in schizophrenia

Background

There is an interest in investigating the relation between emotional memory impairments in schizophrenia and specific symptom dimensions. We explored potential links between emotional memory and social anhedonia severity in patients with schizophrenia and in healthy individuals.

Methods

Twenty-nine patients with schizophrenia and 27 matched healthy individuals completed the Chapman Revised Social Anhedonia Scale and then performed an emotional face recognition memory task involving happy, sad and neutral face expressions. We calculated emotional memory performance using 2 independent measures: the discrimination accuracy index Pr and the response bias Br. We also measured valence ratings of the face stimuli. We performed correlation analyses using the inter-individual variability in social anhedonia severity and the individual score obtained for each memory performance variable and for each face valence rating condition.

Results

Patients with schizophrenia reported higher levels of social anhedonia compared with healthy individuals. They also showed lower recognition accuracy for faces compared with healthy participants. We found no significant correlation between social anhedonia severity and any of the memory performance variables for both patients with schizophrenia and healthy individuals. Regarding potential links between social anhedonia severity and face valence ratings, we found that individuals with elevated social anhedonia had a tendency to rate the face stimuli as more negative.

Limitations

Our negative finding may be partly explained by a lack of statistical power owing to our small patient sample. In addition, our patient sample had unusually high estimated IQ scores, which highlights potential issues regarding the generalization of our findings. Finally, we used a yes–no recognition memory task with a very short retention interval delay.

Conclusion

Our results suggest that social anhedonia is not directly linked to emotional memory deficits and biases and does not interfere with the modulatory effect of positively valenced emotion on memory.     

Homelessness as a predictor of mortality: an 11-year register-based cohort study

Purpose

The purpose of this study was to examine the association between homelessness and psychiatric disorders, including substance use disorders, on one hand, and cause-specific and all-cause mortality on the other in a high-income country.

Methods

A historical nationwide register-based cohort study of the Danish population from 15 years of age between 2000 and 2011 was conducted. The association between homelessness, psychiatric disorders, and mortality was analysed by Poisson Regression adjusting for important confounders. Standardised mortality ratios (SMRs) were calculated for people with a history of homelessness compared with the general population using direct age-standardisation.

Results

During 51,892,324 person-years of observation, 656,448 died. People with at least one homeless shelter contact accounted for 173,592 person-years with 4345 deaths. The excess mortality in the population experiencing homelessness compared with the general population was reduced by 50% after adjusting for psychiatric diagnoses, including substance use disorders (mortality rate ratio (MRR) for men 3.30, 95% CI 3.18–3.41; women 4.41, 95% CI 4.14–4.71). Full adjustment including physical comorbidity and socioeconomic factors in a sub-cohort aged 15–29 years resulted in an MRR of 3.94 (95% CI 3.10–5.02) compared with the general population. The excess mortality associated with homelessness differed according to psychiatric diagnosis, sex, and cause of death.

Conclusions

A mental health or a substance use disorder combined with homelessness considerably increases the risk of death. However, homelessness is also independently associated with high mortality. Differences in the association between homelessness and mortality in men and women suggest the need for sex-tailored interventions.

     

Is the Gly82Ser polymorphism in the RAGE gene relevant to schizophrenia and the personality trait psychoticism?

Background

The receptor for advanced glycation end products (RAGE) is the main receptor for S100B, an astrogial proinflammatory mediator that has been suggested to be involved in the pathophysiology of schizophrenia. To further elucidate the possible relevance of inflammation for mental functions, we investigated a functional polymorphism in the gene coding for RAGE in relation to personality traits and susceptibility to schizophrenia.

Methods

We studied the Gly82Ser polymorphism (rs2070600, 244G>A) in 2 population-based cohorts of middle-aged participants assessed using the Karolinska Scales of Personality. In addition, we compared genotype frequencies between patients with schizophrenia and controls.

Results

The population-based cohorts included 270 women and 247 men, and the case–control study involved 138 patients with schizophrenia and 258 controls. In the population-based cohorts, 82Ser carriers were found to have significantly higher scores for the psychoticism personality trait comprising the detachment and suspicion subscales. The case–control study revealed that the 82Ser allele was significantly more frequent among patients than controls.

Limitations

This study was limited by the modest sample size and the use of a self-report measure to assess personality traits.

Conclusion

Our findings suggest that the proven relation between certain personality traits and schizophrenia can at least to some extent be explained on a genetic level. Also, the activated S100B–RAGE axis may be an underlying cause, not only a consequence, of the disease.