精神分裂症患者服药依从性的影响因素

精神分裂症患者服药依从性问题非常突出,其影响因素复杂。医生在提高患者服药依从性方面可能起主导作用。     

精神分裂症患者对治疗依从性的相关因素分析

作者探讨了影响精神分裂症患者对治疗依从性的相关因素。现将结果报告于后。1　对象与方法1 1　对象　本组共 35 9例精神分裂症患者 ,均符合CCMD- 3精神分裂症的诊断标准 ,其中男性 185例 ,女性 174例 ;年龄 14～ 6 2岁 ,平均 (2 4± 11 5 6 )岁 ,其中年龄≤ 30岁 10 8例 ,>30岁 2 5 1例 ;已婚 193例 ,未婚 16 6例 ;初中文化以下87例 ,初中 131例 ,高中及以上 14 1例 ;家庭关系良好 14 3例(39 8% ) ,一般 135例 (37 6 % ) ,较差 81例 (2 2 6 % )。1 2　方法　采用自编有关因素调查表 ,内容包括年龄、家庭关系、服药数量、精神症状等方面…     

院外精神分裂症患者服药依从性影响因素分析

目的:探讨院外精神分裂症患者服药依从性的影响因素。方法:431例精神分裂症患者出院后按照服药情况分为服药依从性较好(GMC)组和服药依从性较差(PMC)组;对影响服药依从性的个人及家庭因素进行调查和分析。结果:PMC组未婚/离异、文化程度高中以下、家庭关系紧张、未认识服药重要性、药物不良反应发生率明显高于GMC组,服用经典抗精神药率明显低于GMC组(P均0.05)。Logistic回归分析显示文化程度高中以下、家庭关系紧张、药物不良反应、未认识服药重要性、婚姻5个因素是服药依从性的影响因素(OR=11.353、OR=3.857、OR=3.329、OR=2.058、OR=1.788,P均0.05)。结论:院外精神分裂症患者服药依从性的影响因素是文化程度、家庭关系、药物不良反应、对服药的认识及婚姻状况。     

基于ROMI的住院精神分裂症患者服药依从性及相关因素研究

目的 探讨住院精神分裂症患者服药依从性及其影响因素.方法 以住院精神病患者为研究对象,采用药物影响因素评定量表(ROMI)作为评定工具,以半结构式访谈的形式评估入院3周后患者对于抗精神病药物的心理资料,分析ROMI评分与患者人口统计学资料及临床资料的相关性,预测ROMI各因素对依从性的影响程度.结果 患者的人口统计学资料(年龄、学历、工作状态、是否有人监管、住院付费方式)及临床资料(用药种类、病程、住院次数)与ROMI评分无关(P>0.05),药物不良反应与ROMI不依从原因分量表得分呈正相关(P<0.05).患者遵从专家指示、感受到药物对日常生活的益处、害怕复发、家人或朋友对于服用药物有正面意见等因素在促成依从的主观因素中影响较大(P<0.01),患者认为药物不良反应较为缓和、药物可以帮助实现个人目标、与医务人员有良好关系是促成依从影响较普遍的因素(P<0.01).结论 药物不良反应带来的苦恼是不依从的主观原因中影响较普遍的因素,患者遵从专家指示、感受到药物对日常生活的益处、害怕复发、家人或朋友对于服用药物有正面意见等因素对药物依从性影响较大.     

首发精神分裂症患者营养状况调查及影响因素研究

目的 调查首发精神分裂症患者的营养不良状况，并分析其影响因素。方法 采用单纯随机抽样法，选取2020年1月至2022年6月于武汉市精神专科联盟机构入院的450例首发精神分裂症患者为研究对象。入院后收集患者的一般资料，根据欧洲营养不良风险筛查2002标准将首发精神分裂症患者分为营养不良组和营养正常组。采用单因素分析和多因素Logistic回归模型分析影响首发精神分裂症患者营养不良的因素。结果 450例首发精神分裂症患者中，营养不良患者占19.11%(86/450)。单因素分析结果显示，两组患者年龄、体重指数、有无配偶、是否合并骨质疏松症和是否拒食比较，差异有统计学意义（t/χ2=5.066、9.608、5.399、4.712、11.102;P<0.05）。多因素Logistic回归分析结果显示，年龄大（OR=1.446,95%CI=1.148～1.823）和拒食（OR=4.306,95%CI=1.865～9.944）是首发精神分裂症患者营养不良的危险因素（P<0.01），而体重指数高（OR=0.871,95%CI=0.782～0.871）是患者营养不良的保护因素（P<0...     

影响门诊精神分裂症首次发病患者随访一年疗效的相关因素研究

目的 探讨影响精神分裂症首次发病(以下简称首发)患者疗效和复发的相关因素.方法 采用前瞻性队列研究,结合全病程管理模式,对453例符合国际疾病分类第10版精神分裂症和分裂样精神障碍诊断标准、基线阳性和阴性症状量表(PANSS)总分≥60分、病程≤5年的患者,进行1年随访,对13项相关因素与近期疗效及复发情况进行单因素分析,并采用Spearman相关分析和t检验.结果 PANSS总分减分率与性别(r=0.083)、病程(r=-0.228)、起病形式(r=-0.180)、发病诱因(r=0.080)、持续用药时间(r=0.153)存在相关关系(P<0.05～0.01);疾病复发与性别(r=-0.131)、持续用药时间(r=0.131)亦存在相关关系(P<0.01).结论 女性、病程短、起病形式急、病前有诱因、持续用药时间长的精神分裂症首发患者1年的疗效相对好;男性患者及持续用药时间短的患者易复发.     

精神分裂症首次发病患者未治期的影响因素分析

目的：探讨首发精神分裂症患者未治期（ DUP）的影响因素。方法：采用一般资料调查表、阳性与阴性症状量表（ PANSS）、诺丁汉起病症状量表（ NOS）以及疾病家庭负担量表（ FBS）对206例首次发病精神分裂症患者的疾病严重程度、起病形式以及因疾病给家庭带来的负担进行评估。结果：首发精神分裂症患者DUP的中位数为6（2,12）个月,其中男性5（1,12）个月,女性7（2,12）个月,男女比率差异无统计学意义（P>0.05）。将患者分为短DUP组（DUP≤6个月）112例和长DUP组（DUP>6个月）94例比较结果显示,不同DUP组的起病形式（χ2=61.99,P=0.000）、家属对患者的关心程度（t=4.09,P=0.000）、疾病对家庭娱乐活动的影响（t=-2.22,P=0.03）以及疾病对家庭成员心理健康的影响（t=-2.53,P=0.01）两组间存在统计学意义。Logistic 回归分析发现,起病形式（ OR =11.46,95%CI =5.70~23.04）是DUP的危险因素;家属对患者的关心程度（OR=0.73,95%CI=0.60~0.90）是DUP的保护性因素。结论：影响首发精神分裂症患者DUP的因素是多方面的,但起病形式及家属对患者的关心程度是主要因素。     

影响精神分裂症患者治疗依从性的相关因素研究

目的　探索影响门诊精神分裂症患者治疗依从性的相关因素。方法　详细询问和评定 718例精神分裂症患者的治疗依从性 ,并收集其社会经济、家庭、临床和治疗资料 ,以单因素法及逐步多元回归法分析患者的依从性和上述因素的相关性。结果　全样本的依从性类别分布为 :完全依从 5 2 8% ,部分依从 34 7% ,不依从 12 5 %。多元逐步回归分析发现 ,影响治疗依从性的最重要因素为 :副反应、病情和就医条件。结论　对影响精神分裂症患者的治疗依从性的因素应引起更高的重视     

用药态度对精神分裂症患者治疗依从性和症状影响的1年随访研究

目的探讨精神分裂症整合治疗(心理社会干预合并药物治疗)的疗效,分析不同干预方式中用药态度对治疗依从性和精神症状的影响,探讨整合治疗疗效机制。方法 2012年至2015年间纳入170例精神分裂症患者,随机分为整合治疗组(86例)和常规药物治疗组(84例),整合治疗组给予常规药物治疗合并心理社会干预,常规药物治疗组仅给予常规药物治疗,入组3个月、6个月和12个月随访,分别采用用药态度量表(drug attitude inventory,DAI)、自知力问卷(self-awareness inventor,SAI)—治疗依从性量表、阳性和阴性症状量表(positive and negative syndrome scale,PANSS)评估用药态度、治疗依从性、临床精神病性症状。结果随访12月时,整合治疗组PANSS阳性症状和一般精神症状量表减分、DAI和SAI治疗依从性增分均高于药物治疗组(均P0.05),整合治疗组药物依从率高于药物治疗组(72.1%vs.45.2%,P0.01)。常规药物治疗组PANSS总分减分与DAI的增分呈正关联(β=0.31,P=0.02),且治疗依从性的改善中介二者之间的关系(β=0.18,P=0.18);而整合治疗组患者中,未发现DAI增分与PANSS总分减分之间的相关关系(P0.05),SAI—治疗依从性的增分与PANSS量表的阳性症状量表减分(r=0.31,P=0.01)和一般精神症状量表的减分(r=0.36,P0.01)呈正相关。结论本研究表明常规药物治疗组中,用药态度通过提高治疗依从性来改善精神性症状,整合治疗症状改善与治疗依从性改善有关,与用药态度可能无关。     

首发精神分裂症患者就诊途径调查

目的：调查首发精神分裂症患者在精神病医院和非精神病医院就诊途径。方法：完成对71例首发患者及家属调查,包括人口学资料、非精神病专科就诊情况、延迟至精神科求助原因、精神科就诊途径及原因、精神病未治疗期病程等。结果：非精神科主要求助方式为宗教迷信和非专科医生;精神科求助途径主要为家属意愿;精神病未治疗期病程（DUP）中位数为6个月,未发现DUP与其他调查因素相关;造成延迟至精神科求助主要原因是患者及家属对精神卫生知识缺乏。结论：加强社区精神卫生知识宣传普及对于缩短DUP非常必要。     

首发精神分裂症患者5年随访研究

目的：探讨首发精神分裂症患者5年预后,生活质量及其相关影响因素。方法：采用自制的一般情况调蠢衷,阳性和阴性症状量表（PANSS）。健康状况调查问卷（SF-36）,家庭负担量表（FIS）对86例患者及其家属进行问卷调查。结果：男性患者生活质量中的角色功能的分值高于女性,而躯体疼痛和社会功能的分值女性明显高于男性患者。患者的PANSS总分和各因子分与躯体功能呈显著负相关,PANSS总分、阴性症状分以及一般精神病理分与患者生活质量中的角色功能、社会功能以及角色情绪因子呈显著负相关。患者生活质量中的生理机能、生理职能和情感职能因子分与FIS中的经济负担、对家庭日常活动的扰乱、对家庭娱乐活动的影响以及对家庭关系的影响之间存在明显的负相关。结论：经济状况、精神症状等因素是影响患者生活质量的重要因素。     

首次发病的青少年精神分裂症患者执行功能的研究

目的:探讨首次发病的青少年精神分裂症患者执行功能及其与精神症状的关系. 方法:采用威斯康星卡片分类测验(WCST)及韦克斯勒记忆量表第3版(WMS-Ⅲ)空间广度测验测试75例首次发病的青少年精神分裂症患者(病例组)和80名健康对照者(对照组)的执行功能;病例组同时应用阳性和阴性症状量表(PANSS)评定病情. 结果:病例组WCST的错误总数、持续反应数和持续错误数显著高于对照组,正确总数显著低于对照组(P均＜0.01);WMS-Ⅲ总分和空间广度逆行分显著低于对照组(P均＜0.05).病例组PANSS阴性症状分与WMS-Ⅲ空间广度逆行分及总分负相关(r=-0.276,r=-0.230;P均＜0.05);阳性症状分与WCST完成分类数负相关(r=-0.258,P＜0.05);一般病理学总分与WMS-Ⅲ空间广度逆行分负相关(r=-0.244,P＜0.05). 结论:首次发病的青少年精神分裂症患者执行功能显著受损,并与病情有关.     

Psychopathology and treatment responsiveness of patients with first-episode schizophrenia

One hundred and four male patients hospitalized for the first time with the diagnosis of first-episode schizophrenia were comprehensively assessed on admission and discharge. Psychopathology, treatment response, and remission rates were evaluated (based on the Positive and Negative Syndrome Scale (PANSS), severity of symptoms only). On admission, the most frequently observed symptoms were lack of judgment and insight (87.6%), suspiciousness/feelings of persecution (82.3%), delusions (77%), poor attention (70%), disturbance of volition (65.4%), conceptual disorganization (64.7%), and active social avoidance (64%). Except for delusions and hallucinations, the positive items of the PANSS correlated significantly with negative symptoms, and conceptual disorganization correlated with the greatest number of negative symptoms. Individual negative symptoms were present in about half the patients. At discharge, the most frequent symptoms were again lack of judgment and insight (in 55.7%), and for negative symptoms they were blunted affect (22.1%), emotional withdrawal (21.2%), and passive/apathetic social withdrawal (19.5%). The positive symptoms of suspiciousness/feelings of persecution and grandiosity persisted in 20.6% of patients. On average, all symptoms were significantly reduced 44 days after admission. The negative symptoms improved less, compared with the positive ones. At discharge there was a high rate of responders (response defined as minimal 30% reduction of total PANSS): 73% and 74% of patients fulfilled the criteria for remission. On admission, the responders (n = 76) had significantly higher scores of most symptoms, both positive and negative ones than nonresponders (n = 28).     

Medication adherence in schizophrenia: exploring patients', carers' and professionals' views

One of the major clinical problems in the treatment of people with schizophrenia is suboptimal medication adherence. Most research focusing on determinants of nonadherence use quantitative research methods. These studies have some important limitations in exploring the decision-making process of patients concerning medication. In this study we explore factors influencing medication adherence behavior in people with schizophrenia using concept mapping. Concept mapping is a structured qualitative method and was performed in 4 European countries. Participants were 27 patients with schizophrenia, 29 carers, and 28 professionals of patients with schizophrenia. Five clinically relevant themes were identified that affect adherence: medication efficacy, external factors (such as patient support and therapeutic alliance), insight, side effects, and attitudes toward medication. Importance ratings of these factors differed significantly between professionals and carers and patients. Professionals, carers, and patients do not have a shared understanding of which factors are important in patients' medication adherence behavior. Adherence may be positively influenced if professionals focus on the positive aspects of medication, on enhancing insight, and on fostering a positive therapeutic relationship with patients and carers.     

Predictors of poor adherence to medication among patients with first-episode schizophrenia-spectrum disorder

Aim: This study sought to identify predictors for poor adherence to medication among patients with first‐episode schizophrenia‐spectrum disorder. Methods: Medication adherence was measured 1 and 2 years after initiation of antipsychotic medication in a follow‐up study of 547 patients. Relevant variables were systematically assessed at baseline, 1‐ and 2‐year follow up. Results: Most patients have difficulties with medication adherence over time. Negative attitudes towardsmedication and lack of consistent family support are the strongest predictors for poor adherence to medication for first‐episode psychotic patients in the first 2 years. After 1 year of treatment, unawareness of the effect of medication, lack of positive attitudes towards medication, substance abuse, young age and high global functioning also predict poor adherence to medication. Conclusions: A number of variables were independently associated with poor adherence. Rating of insight and attitudes towards medication makes it possible to predict poor adherence in incident cases with schizophrenia.     

奥氮平和奎硫平治疗首发精神分裂症对照研究

目的:比较奥氮平和奎硫平治疗首发精神分裂症的疗效和安全性。方法:将80例符合中国精神障碍分类与诊断标准第3版诊断标准的首发精神分裂症患者,随机平分为奥氮平组和奎硫平组各40例。疗程6周。采用阳性与阴性症状量表(PANSS)、副反应量表(TESS)评定疗效与不良反应。结果:奥氮平组阳性症状评分下降显著大于奎硫平组;两组阴性症状、一般精神病理症状和PANSS总分下降差异无显著性(P>0.05)。奥氮平组主要不良反应为体质量(体重)增加、肝功能损害和锥体外系症状;奎硫平组主要不良反应为嗜睡和头昏。结论:奥氮平对精神分裂症阳性症状的疗效优于奎硫平,两药不良反应均相对较轻。     

Shortening of the hippocampal formation in first-episode schizophrenic patients

Abstract Shortening of hippocampal formation (HF) in chronic schizophrenic patients have been demonstrated in our previous study. The purpose of the present study is to test if shortening of the HF occurs in schizophrenic patients suffering their initial psychotic episode. We performed contiguous, 1 mm thick, magnetic resonance imaging scans in 20 first-episode schizophrenic patients, 21 chronic schizophrenic patients, and 25 healthy subjects. Both groups of schizophrenic patients demonstrated significant shortening of the HF compared with normal controls (first-episode schizophrenia, 5.3%; chronic schizophrenia, 8.0%). However, the HF length was not significantly different between the first-episode and chronic schizophrenic patients. No significant correlation was seen between the HF length and the duration of illness in chronic schizophrenic patients. These results suggest that the HF shortening observed in schizophrenic patients may be genetic and/or developmental in origin.     

Duration of untreated psychosis and pathways to psychiatric services in first-episode schizophrenia

The aim of the present study was to examine the duration of untreated psychosis (DUP) in first-episode schizophrenia patients in Japan and to investigate the available pathways to psychiatric services. Eighty-three patients who visited Keio University Hospital (n = 54) or Oizumi Mental Hospital (n = 29) were evaluated retrospectively with regard to their DUP, living situation, social participation level, referral pathway, reason for seeking treatment, and their global assessment of functioning (GAF) score. The mean DUP was 13.7 months (median, 5.0 months) overall. No significant difference in DUP was found between subjects living alone and those living with others; however, employed patients had a significantly shorter DUP (8.1 months) than unemployed patients (18.7 months). Pathways to psychiatric services were totally different between the two institutions. Fifty-two subjects (62.7%) came to the services directly: 40 patients (74.1%) came to the university hospital and 12 patients (41.4%) came to the mental hospital. At the mental hospital, nine patients (31.0%) had been admitted because of a legal obligation, and six (20.7%) had been referred through public health centers. None of the patients had been referred to either of the services by general practitioners. The main reason for seeking treatment was psychiatric symptom aggravation (59.3%) at the university hospital and acting out (64.3%) at the mental hospital. Some universal psychosocial factors appear to influence the DUP but the characteristics of specific psychiatric services may also affect treatment delays.