精神分裂症患者再住院率研究

目的:比较出院后精神分裂症患者以利培酮、氯氮平、低效价和高效价传统抗精神病药治疗者的再住院率。方法:对833例1999年内出院的精神分裂症患者调查,于2003年12月底前调查患者出院后至少48个月的情况。结果:601例完成调查,利培酮组81例,氯氮平组177例,低效价传统药组161例和高效价传统药组182例,4组的未再住院率,12个月(分别为59.3%、65.5%、65.2%和67.6%)、24个月(53.1%、52.0%、55.9%和51.1%)3、6个月(48.2%、36.7%、44.7%和36.8%)和48个月(42.0%、31.1%、39.1%和30.2%),差异均无显著性(P均>0.05)。利培酮的药物完全依从率高(60.5%)。结论:精神分裂症患者不同抗精神病药物治疗出院后的再住院率相当。     

精神分裂症患者出院后药物治疗依从性的影响因素分析

目的:探讨精神分裂症患者出院后药物治疗依从性及相关影响因素。方法:对175例出院后的精神分裂症患者进行6个月的随访调查,通过电话、入户或门诊随访完成自编《精神分裂症患者药物治疗依从性调查问卷》,分析患者出院后药物治疗依从性及影响依从性的相关危险因素。结果:精神分裂症患者出院后药物治疗依从率仅为61. 1%(107/175例);影响患者出院后药物治疗依从性的危险因素包括缺乏疾病相关知识(OR=2. 319,95%CI:1. 56～3. 07)、药物不良反应(OR=6. 209,95%CI:4. 768～7. 650)、药物种类(OR=1. 931,95%CI:1. 257～2. 605)、对医师的信任较差(OR=2. 855,95%CI:1. 908～3. 801)、门诊不定期复诊(OR=3. 300,95%CI:2. 181～4. 419)及缺乏家庭支持(OR=4. 319,95%CI:2. 935～5. 703)等(P 0. 05或P 0. 001)。结论:精神分裂症患者出院后的药物治疗依从性较差,与缺乏疾病相关知识、药物不良反应、不定期复诊、缺乏家庭支持等影响因素有关。     

首次住院精神分裂症656例临床资料分析

目的　了解精神分裂症病人首次住院的临床情况。方法　对 6 5 6例精神分裂症患者首次住院的临床症状、分型、起病形式、诱发因素、疗效、病前个性和家族遗传史等情况进行回顾性分析。结果　平均起病年龄 (2 7 0 9± 10 2 2 )岁 ,有家族史和个性内向型者起病年龄较早。平均病程为 (4 5 9±6 88)年 ,男性在婚率 (4 0 4 7% )明显低于女性 (6 0 % ) (P <0 0 1)。偏执型为最多 (4 1 0 1% ) ,其次是未分化型 (39 4 8% )和青春型 (12 96 % ) ,男性偏执型 (4 4 5 7% )多于女性 (37 14 % ) ,女性未分化型(37 4 6 % )多于男性 (32 85 % )。 5 2 4 4 %有原发妄想 ,4 3 75 %行为怪异。缓慢起病者 (5 8 6 9% )多于急性起病者 (19 0 5 % )。急性起病者显好率 (77 6 0 % )高于缓慢起病者 (5 9 74 % ) (P <0 0 1)。结论　比较全面地了解了青浦地区精神分裂症病人首次住院时的临床资料 ,对疾病的防治和精神卫生知识的宣传有一定的参考意义     

反复住院的精神分裂症患者住院周期特征

目的:探讨反复住院的精神分裂症患者住院周期特征。方法:分析170例住院≥4次精神分裂症患者因精神分裂症的出、入院资料。结果:本组患者住院4~18次/例;平均(5.3±2.1)次/例;第2及4~9次住院时间显著长于第1次(P均0.05);第3~8次住院间隔时间显著短于第1次(P均0.05)。结论:反复住院患者的精神分裂症患者随着住院次数增加,住院时间呈延长、住院间隔时间呈缩短的趋势。     

城乡精神分裂症复发因素比较

对再住院的城市和农村的精神分裂症患者 10 0例及其亲属进行调查 ,了解其复发的可能因素。1　对象和方法为 2 0 0 1年 3月起连续再次入住我院 ,且上次出院疗效达临床显著进步以上的城市和农村精神分裂症患者各 10 0例 ,均符合中国精神疾病分类方案与诊断标准第 2版修订本诊断标准。采用自编的半定式问卷 ,询问患者及其亲属或护送人员 ,了解一般资料及临床资料。2　结果一般资料 :城市组男 5 6例 ,女 4 4例 ;平均年龄 (2 9 3±7 3)岁 ;病程 6个月～ 15年 ,平均 (3 0± 1 1)年 ;住院次数 2～ 8次 ,平均 (3 3± 1 7)次 ;平均受教育 (10 5± 4 …     

精神分裂症患者出院后服药情况调查

对精神分裂症患者院外服药情况进行调查 ,报告如下。1　对象和方法为 1996年 6月至 1997年 5月期间出院的精神分裂症患者 ,共 12 0例 ,其中男 6 4例 ,女 5 6例 ;年龄 17～ 5 9岁 ,平均(2 7 0± 8 6 )岁 ;有偶 71例 ,无偶 4 9例 ;住院 1次 90例 ,2次 8例 ,≥ 3次 2 2例 ;病程 (2 2 0± 14 8)个月 ;出院时痊愈 5 0例 ,显著进步 32例 ,好转 2 9例 ,无效 9例。2　结果出院后抗精神病药维持情况不一 ,有的出院后即停药 ,有的随访 18个月以上仍在服药。有 4 1例复发 ,复发率为34 2 %。停药越早复发率越高。见表 1。表 1　停药与复发关系 (例数 ,…     

精神分裂症老年患者服药依从性和血药浓度检测的意义

目的　探索精神分裂症老年患者服用抗精神病药的依从性与血药浓度的关系及其临床意义。方法　观察 180例门诊中精神分裂症老年患者 ,其中单一服用氯丙嗪 5 8例、奋乃静 6 5例、氯氮平 4 0例、氟哌啶醇 17例。患者于入组后 2周和 3个月末分别检测血药浓度 ,评定其服药依从性、疗效和副反应。结果　应用氯丙嗪、奋乃静或氯氮平者在剂量相仿时 ,其血药浓度为完全依从者高于部分依从者 ,部分依从者高于不依从者 (F检验 ,P <0 0 1)。完全依从者的血药浓度与剂量呈显著性正相关 (Pearson检验 ,r=0 4 3～ 0 6 2 ,P <0 0 5或 <0 0 1)。血药浓度过低者的痊愈 +显著进步率为 5 1 2 % ,远低于血药浓度中 (72 2 % )高 (70 8% )者。血药浓度过高者的副反应发生率达 4 4 6 % ,明显高于血药浓度中 (2 5 0 % )低 (2 3 3% )者。结论　服药依从性与疗效密切相关 ,精神分裂症老年患者的服药依从性评估和血药浓度检测非常重要。     

住院精神分裂症患者节日期间心理状况的调查分析及护理

本文调查 16 2例住院精神分裂症患者在节日期间心理状态 ,旨在探讨在此期间如何对其进行心理护理。现报告如下。1　资料与方法1.1　病例选择　全部为我院的住院病例。入组标准 :①符合临床大体评定量表评分 ,分值范围为 6 1～ 70分 ;② )无任何躯体疾病 ;③年龄在 4 0岁以下 ;④从 395例住院患者中 ,随机抽出 16 2例符合ＣＣＭＤ - 2 -Ｒ中精神分裂症诊断标准者 ;⑤首次入院 ,病程在 3年以内 ,住院时间 3～ 12个月 ;⑥精神症状缓解 ,自知力基本 (部分 )恢复 ;⑦全部为男性 ,平均年龄 (36 .11± 4 .2 2 )岁 ,平均病期 (2 2 .4 8± 8.55)个月 …     

利培酮维持治疗精神分裂症的长期效果

目的　探讨利培酮维持治疗精神分裂症的效果。方法　对利培酮治疗出院的 57例精神分裂症患者进行 3年随访 ,以总体印象量表 (CGI)、副反应量表 (TESS)及社会功能缺陷量表 (SDSS)评估利培酮维持治疗的社会康复状况 ,临床疗效与药物副反应等 ,并与氯氮平治疗的同类病人 57例进行对照。结果　利培酮组CGI得分中EL :1 72± 0 71 ,较氯氮平组 1 59± 0 59显著性增高 (t=0 99,P <0 .0 5)。利培酮与氯氮平组TESS分别为 1 2 6± 0 87和 1 0 5± 0 85,无显著差异。利培酮与氯氮平组SDSS评分分别为3 1 8± 2 78和 5 2 3± 2 52 (t=2 1 8,P <0 0 0 1 ) ,具有显著性差异。利培酮与氯氮平治疗病人 3年内复发率分别为 2 4 6%和 3 8 6% ,χ2 =3 1 8,P <0 0 0 1 ,再住院率分别为 1 0 6%和 53 1 % ,χ2 =8 3 ,P <0 0 1 ,均具有显著性差异。结论　两种药物治疗出院后的精神分裂症患者 ,以利培酮维持治疗可获得较好疗效而且社会功能康复效果均优于氯氮平组病人     

1986年至2006年间4个年份唐山市精神分裂症住院患者抗精神病药物使用变化趋势

目的 分析近20年精神分裂症住院患者抗精神病药物治疗种类和剂量变化趋势.方法 调查1986年、1996年、2001年和2006年4个年份在唐山市6所精神病院出院的2 718例精神分裂症患者的3 195份住院病历,用专门设计的调查表记录患者的社会人口学资料、疾病特征以及患者出院时药物治疗信息.结果 ①治疗药物的变化:1986年、1996年、2001年和2006年最常使用的抗精神病药物分别是第一代抗精神病药物、氯氮平、氯氮平、除氯氮平外的第二代抗精神病药物,使用率分别为93.8%(396/422)、45%(285/634)、59.9%(557/930)、51.6%(623/1206).2006年氯氮平使用率达35.7%(431/1206).4个年份间患者出院时合并使用2种以上抗精神病药物治疗的比例旱升高趋势(趋势X~2=99.10,P＜0.001),从1986年的10.43%(44/422)渐升至2006年的26.29%(317/1209).②药物剂量变化:4个年份出院时患者服用抗精神病药物的氯丙嗪等效日剂量组间比较差异有统计学意义(Kruskal-Wallis X~2=43.32,P＜0.001),4个年份的出院患者日服药剂量随年份增长而呈下降趋势(Spearman R=-0.13,P＜0.001);抗精神病药的单一治疗日剂量低于合并治疗,差异有统计学意义(Kruskal-Wallis X~2=14.23,P＜0.001).③多元回归分析表明,患者出院时服用抗精神病药物的氯丙嗪等效剂量与抗精神病药物联合治疗(b=163.86,P＜0.001)、住院大数(b:25.76,P＜0.001)呈正相关;与使用第二代抗精神病药物(b=-114.92,P＜0.001)、发病年龄(b=-3.87,P＜0.001)呈负相关.结论 近20年第二代抗精神病药物已逐渐成为抗精神病治疗的主要用药,抗精神病药合并治疗的比例增加.临床实践中应考虑到氯氮平一直保持较高使用率的利弊和合并用药可能带来的药物不良反应.     

Depression is a risk factor for rehospitalization in medical inpatients

Background: Rehospitalization occurs in approximately 20% of medical inpatients within 90 days of discharge. Rehospitalization accounts for considerable morbidity, mortality, and costs. Identification of risk factors could lead to interventions to reduce rehospitalization. The objective of the study was to determine if physical and mental health, substance abuse, and social support are risk factors for rehospitalization.Method: This was a prospective cohort study in an innercity population conducted from September 2002 to September 2004. Participants included 144 adult inpatients with at least 1 hospital admission in the past 6 months. Measurements included age, length of stay, number of admissions in the past year, and medical comorbidity as well as measures of depression, alcohol and drug abuse, social support, and health-related quality of life. The outcome studied was the rehospitalization status of participants within 90 days of the index hospitalization.Results: The mean age of the subjects was 54.8 years; 48% were black and 78% spoke English as a primary language. Subjects were admitted a mean of 2.5 times in the year before the index admission. Sixty-four patients (44%) were subsequently rehospitalized within 90 days after the index admission. In bivariate analysis, rehospitalized patients had more prior admissions (median of 3.0 vs. 2.0 admissions, p = .002), greater medical comorbidity (mean Charlson Comorbidity Index score of 2.6 vs. 2.0, p = .04), and poorer physical functional status (mean SF-12 physical component score of 31.5 vs. 36.2, p = .03). A logistic regression model, including prior admissions in the last year, comorbidity, physical functional status, and depression, showed that depression tripled the odds of rehospitalization (odds ratio = 3.3, 95% CI = 1.2 to 9.3). This model had fair accuracy in identifying patients at greatest risk for rehospitalization (c statistic = 0.72).Conclusions: Hospitalized patients with a history of prior hospitalization within 6 months who screen positive for depression are 3 times more likely to be rehospitalized within 90 days in this relatively high-risk population. Screening during hospitalization for depressive symptoms may identify those at risk for rehospitalization.     

Effects of diagnosis and treatment history on relapse of psychiatric patients

Of 400 patients followed up for 1 year after release from the hospital, 34% were readmitted during that year. For schizophrenic patients the readmission rate was 49%, and for nonschizophrenic patients it was 21%. Rate of rehospitalization was positively related to number of prior hospitalizations, cumulative months of prior hospitalization, and duration of illness, but the relationship varied between the schizophrenic and nonschizophrenic groups. In contrast to the findings of Linn and associates, in this study prior hospitalization of nonschizophrenic patients markedly increased the likelihood of rehospitalization.     

Age and other factors relevant to the rehospitalization of schizophrenic outpatients

In this study 50 of 51 schizophrenic long-term patients treated by a community-based outpatient service were followed-up for 2 years. Factors known to be relevant for rehospitalization were correlated with the rate of hospitalizations 1) in the past, 2) during the last year and 3) during the follow-up period. We were particularly interested in the influence of the patient's age on readmission. In agreement with previous research, the results showed that the best predictor of future admissions was the number of previous hospitalizations. Age also has a high predictive value and correlates not only significantly with the hospitalization rates but also with other factors relevant for readmission such as drug compliance, antisocial behavior and suicidal risk. This, however, only partly explains the frequency of rehospitalization, as partial correlation shows. Although items concerning compliance were highly correlated with previous hospitalizations, they had less predictive value, contrary to the findings in the literature.     

Rehospitalization rates of patients recently discharged on a regimen of risperidone or clozapine.

OBJECTIVE: The purpose of this study was to examine rehospitalization rates of people receiving risperidone or clozapine who had been discharged from state psychiatric hospitals in Maryland. METHOD: Rehospitalization status was monitored for all patients discharged from state psychiatric facilities on a regimen of either risperidone or clozapine between March 14, 1994, and Dec. 31, 1995. Patients were followed up with respect to readmission until Dec. 31, 1996. Time to readmission was measured by the product-limit (Kaplan-Meier) formula. Risk factors associated with rehospitalization were examined. RESULTS: One hundred sixty patients were discharged on risperidone, 75 having the diagnosis of schizophrenia. The patients with schizophrenia were more likely to be readmitted than the 85 patients with other mental disorders. Recidivism rates for schizophrenic patients discharged on risperidone versus those discharged on clozapine were not significantly different over the 24-month study period. However, no patient who received clozapine and remained discharged for more than 10 months (N = 49) was readmitted, while the readmission rate for risperidone-treated patients appeared to be steady up to 24 months. At 24 months 87% of the clozapine-treated patients and 66% of the risperidone-treated patients remained in the community. No clinical or demographic variables were found to predict rehospitalization. CONCLUSIONS: This study demonstrates that the rehospitalization rates of patients taking the second-generation antipsychotics risperidone and clozapine are lower than those in previously published reports of conventional antipsychotic treatment.     

Psychoeducation and compliance in the treatment of schizophrenia: results of the Munich Psychosis Information Project Study

OBJECTIVE: The present study examined whether psychoeducational groups for patients with schizophrenic disorders and for their families can reduce rehospitalization rates and improve compliance. METHOD: 236 inpatients who met DSM-III-R criteria for schizophrenia or schizoaffective disorder and who had regular contact with at least 1 relative or other key person were randomly assigned to 1 of 2 treatment conditions. In the intervention condition, patients and their relatives were encouraged to attend psychoeducational groups over a period of 4 to 5 months. The patients' and relatives' psychoeducational programs were separate, and each consisted of 8 sessions. Patients in the other treatment condition received routine care. Outcomes were compared over 12-month and 24-month follow-up periods. The study was conducted from 1990 to 1994. RESULTS: It was possible to significantly reduce the rehospitalization rate after 12 and 24 months in patients who attended psychoeducational groups compared with those receiving routine care (p < .05). Patients who attended psychoeducational groups showed better compliance than patients under routine care without psycho-education. CONCLUSIONS: The results suggest that a relatively brief intervention of 8 psychoeducational sessions with systematic family involvement in simultaneous groups can considerably improve the treatment of schizophrenia. Psychoeducation should be routinely offered to all patients with schizophrenia and their families.     

精神分裂症患者的服药依从性

目的;研究精神分裂服药依从性及其相关因素。方法：对３８８例门认孤精神分裂症患者进行中力,服药依从性与简明精神病量表（ＢＰＲＳ）,社会功能陶陷筛选量表（ＳＤＳＳ）及副反应量表（ＴＥＳＳ）的评定与分析。结果：服药依从者６９．１％,病程〉５年者依从性比≤５年者差;自知力障碍越重者依从性越差;ＢＰＲＳ总分其思维障碍、敌对猜因子分越高者依从性越差;ＳＤＳＳ及ＴＥＳＳ“Ａ”栏（严重度）评分越高者依从性越差。结     

精神分裂症患者服药依从性的调查

目的:调查社区精神分裂症患者服药依从性及其相关因素。方法:对287例免费服药治疗的精神分裂症患者进行病程,一般情况调查表,自知力,服药依从性与简明精神病评定量表(BPRS),社会功能缺陷筛选量表(SDSS)及治疗中出现的症状量表(TESS)的评定与分析。结果:服药依从者70.7%;病程>5年者依从性比≤5年者差;文化程度初中及以下;服用经典抗精神病药组(包括氯氮平);自知力障碍重者依从性差;BPRS总分其思维障碍、敌对猜疑因子分越高者依从性越差;SDSS及TESS(严重度)评分越高者依从性越差。结论:提示患者文化程度高、社会支持系统好、药物不良反应小、有自知力者服药依从性好。     

住院精神分裂症患者主观舒适度的影响因素分析

目的 了解影响精神分裂症患者主观舒适度的相关因素。方法 对200例住院精神分裂症患者测评“抗精神病药物治疗中主观舒适度（SWN）简表”及自制的“相关因素调查表”。结果 住院精神分裂症患者SWN评分异常率为31％，SWN评分异常组与正常组相比，在总病程、住院次数、服药次数、药物剂量、家庭经济水平、服药依从性、社会支持、医患关系、诊断亚型、合并使用抗副作用药、藏药行为等方面差异显著。2项Logistic回归分析显示，精神分裂症患者主观舒适度影响因素依次为：药物剂量、合并使用抗副作用药、服药依从性、藏药行为、家庭经济水平、医患关系。结论 在治疗精神分裂症患者时应注意多因素对主观舒适度的影响，尤其注意发挥人为干预因素作用。