首发精神分裂症患者的生活质量评估

目的评估首发分裂症患者的生活质量，及生活质量与精神症状的相关性。方法评估447例患者基线、随访6个月、随访1年时阳性和阴性症状量表（PANSS）、健康状况调查问卷（SF-36）、社会功能缺陷筛选量表（SDSS）、生活满意度量表（LSR）。主要根据SF-36评估首发分裂症患者的生活质量，并将SF-36与PANSS、SDSS、LSR作相关分析。结果首发精神分裂症患者在躯体角色功能（RP）、社会功能（SF）、情绪角色功能（RE）3个维度平均分显著低于杭州市居民的数据。除精力（VT）外，其余7个维度与PANSS的阳性症状分、阴性症状分、一般精神病理分以及SDSS均呈负相关，与LSR呈正相关。而VT与PANSS的阴性症状分及LSR呈负相关。随访1年问躯体健康（PF）、躯体角色功能（RP）、躯体疼痛（BP）、总体健康（GH）、社会功能（SF）、情绪角色功能（RE）、心理健康（MH）等7个维度得分显著提高。结论首发分裂症患者的情绪角色功能、躯体角色功能和社会功能受损明显，经1年治疗后上述功能均能明显改善。除精力感外，精神症状缓解越明显，生活质量越高，提示了早期治疗的重要性。同时也表明SF-36可适用于评估分裂症患者的生活质量。     

Anxiety disorders in outpatients with schizophrenia: prevalence and impact on the subjective quality of life

OBJECTIVE: To describe the prevalence of comorbid lifetime anxiety disorders in outpatients with schizophrenia and to compare the subjective quality of life of patients with and without comorbid anxiety disorders. METHODS: Fifty-three outpatients were recruited. They were interviewed with the Anxiety Disorders section of the SCID for DSM-IV. Quality of life was assessed with the Sheehan disability scale (SDS). RESULTS: Specific prevalences of anxiety comorbidity were: social phobia (17%), OCD (15.1%), GAD (9.4%), anxiety disorder NOS (7.5%), panic disorder (5.7%), specific phobia (5.7%), PTSD (3.8%), and agoraphobia (1.9%). Schizophrenic patients with comorbid anxiety disorder (41.5%) showed significantly higher scores in global scale (p=0.005), work subscale (p=0.007), and social life subscale (p=0.003) of the SDS than their counterparts without comorbid conditions. CONCLUSIONS: Anxiety disorders may impose an additional burden to patients with schizophrenia, resulting in further decline in their subjective quality of life.     

Cognitive dimensions in first-episode schizophrenia spectrum disorders

BACKGROUND: The severity and pattern of cognitive deficits in epidemiological cohorts of patients with first-episode schizophrenia spectrum disorders still remains unclear. We aimed to characterize the basic cognitive functioning of a representative sample of patients with a first-episode schizophrenia spectrum disorders. METHOD: One hundred thirty-one patients experiencing first-episode psychosis and 28 healthy volunteers were administered a comprehensive neuropsychological evaluation. To reduce the number of cognitive test measures into meaningful cognitive dimensions, before analyzing differences between patient and healthy volunteer samples, exploratory factor analysis was carried out on data collected in patients group. The method of extraction was Principal Components Analysis with oblique rotation. RESULTS: An eight-factor model including verbal learning/memory, verbal comprehensive abilities, speed of processing/executive functioning, motor dexterity, motor speed, sustained attention, and impulsivity emerged. A significant below average performance in all cognitive dimensions, except impulsivity, was found. Patient's performance in speed of processing/executive functioning, motor dexterity and sustained attention dimensions exceeded one standard deviation below healthy comparison subjects. CONCLUSIONS: At early stages of the illness, patients display a marked impairment in several functionally relevant cognitive domains.     

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。     

Randomized double blind comparison of olanzapine vs. clozapine on subjective well-being and clinical outcome in patients with schizophrenia

OBJECTIVE: This randomized double-blind multicenter trial evaluated the effects of olanzapine vs. clozapine on subjective well-being, quality of life (QOL) and clinical outcome. METHOD: The primary objective was to demonstrate non-inferiority of olanzapine, mean dosage 16.2 +/- 4.8 (5-25 mg/day) vs. clozapine, mean dosage 209 +/- 91 (100-400 mg/day) regarding improvement on the 'Subjective Well-Being under Neuroleptic Treatment' (SWN) Scale after 26 treatment weeks in 114 patients with schizophrenia. Secondary outcome parameters included: Munich QOL Dimension List (MLDL), Positive and Negative Symptom Scale (PANSS), Clinical Global Impression (CGI). RESULTS: SWN scores improved significantly in both groups, olanzapine was non-inferior to clozapine (group difference 3.2 points in favor of olanzapine; 95% CI: 4.2;10.5). MLDL-satisfaction, PANSS and CGI-S improved similarly, olanzapine yielded a higher CGI Therapeutic Index. Individual SWN and PANSS changes correlated only moderately (r = -0.45). CONCLUSION: Olanzapine was non-inferior to clozapine. The lack of a marked correlation between PANSS and SWN improvements indicates that patients and psychiatrists perceive treatment differently.     

慢性精神分裂症患者的生活质量评估研究

目的评估慢性精神分裂症患者的生活质量,及生活质量与精神症状的相关性。方法在齐齐哈尔医学院第四附属医院住院的慢性精神分裂症患者158例,以年龄、性别、受教育程度为匹配条件,按照2∶1的比例选择本院职工及医院所在社区内79例健康自愿者为对照组。采用健康状况调查问卷（SF-36）进行生活质量评价,同时评估158例患者基线（即入院时）、随访6个月、1年时阳性和阴性症状量表（PANSS）、社会功能缺陷筛选量表（SDSS）、生活满意度量表（LSR）,并将SF-36与PANSS、SDSS、LSR作相关分析。结果患者SF-36各维度评分均低于对照组,两组比较差异有显著意义。患者组SF-36各维度评分与PANSS的阳性症状分、阴性症状分、一般精神病理分以及SDSS均呈负相关,与LSR呈正相关。随访1年间SF-36评分各维度得分显著提高。结论慢性精神分裂症患者的生活质量低下,经1年治疗后上述功能均能明显改善。精神症状缓解越明显,生活质量越高,提示了慢性精神分裂症患者治疗的重要性。同时也表明SF-36可适用慢性精神分裂症患者生活质量的评估。     

精神分裂症患者生活质量与非理性信念的关系研究

目的分析探讨精神分裂症患者生活质量与非理性信念的关系,为认知行为治疗提高患者的生活质量提供理论指导。方法选取符合DSM—IV中精神分裂症诊断标准的医院门诊和住院患者共200例,采用世界卫生组织生存质量测定量表简表（wHOQOL—BREF）和非理性信念量表（IBS）对患者进行测评,收回有效问卷182例,分析患者生活质量与非理性信念的相关性。结果患者生活质量总分及4个因子分与非理性信念的低挫折耐受呈负相关（r分别为-0．348,-0．405,-0．309,-0．256,-0．394;P〈0．01）,与概括化评论呈负相关（r分别为-0．357,-0．401,-0．325,-0．295,-0．413;P〈0．01）。低挫折耐受和概括化评论可以作为总体生活质量和心理因子的预测指标（F分别为21．231,21．015;P〈0．01）;概括化评论可以作为总体生活质量及生理、社会关系、环境因子的预测指标（F分别为15．292,12．020,9．011;P〈0．01）。结论精神分裂症患者的非理性信念影响患者的生活质量的各个层面,非理性信念中的低挫折耐受和概括化评论可作为患者生活质量的预测指标。     

Objective and subjective quality of life of first-admitted women and men with schizophrenia

Empirical studies have shown that there are differences between women and men with respect to the onset of schizophrenia and the development of their mental and social conditions. It was therefore the goal of this study to assess the objective life situation and subjective quality of life, as well as the differences, similarities and interrelations, at the onset of schizophrenia in women and men. Ninety schizophrenic patients were interviewed between the second and fourth weeks of their first hospital stay using the Berlin Quality of Life Profile, and rated according to the BPRS. Areas of social problems (work, living circumstances, safety and drug abuse) had become manifest with several of the patients, particularly among the young men, prior to first admission. Although objective conditions, gender and psychopathology have an impact on the subjective quality of life, it cannot be fully explained by them. Multivariate analyses have demonstrated that the factors influencing it are probably different for women and men, and schizophrenic women appraise their life circumstances in a different manner from men, as is true for differences between the statements of acutely and chronically ill patients. It can be concluded from the results of this study that psychiatric services should offer specific social support measures before or at first hospital admission and not after the illness has become chronic. The subjective construct of global quality of life apparently differs from one sample to another, and gender-related aspects, among others, have an impact on it. Received: 2 June 1997 / Accepted: 14 July 1998     

Short-term remission in schizophrenia as a combination of several outcome measures

Clinical, cognitive, metabolic and functioning variables have been evaluated in patients with schizophrenia in an 8-week trial with Ziprasidone. The aim of this post-hoc analysis is to investigate how these variables interact in determining short-term remission. Baseline values or the variation from baseline to endpoint were considered predictors. 262 schizophrenic patients were recruited. Two logistic regressions were conducted to determine which variables predict remission. The first was performed on baseline values as predictors. The second used the variation from baseline to endpoint (delta) of the outcome evaluations as predictors. Using literature reported criteria for remission, we distinguished 124 subjects (47.33%) in remission, and 138 not in remission at the end of the trial. The first logistic regression does not show a good fit. The second logistic regression, with delta scores as predictors, reports instead an overall good fit (71.8% of the predicted cases assigned to the right category). The analysis reveals that general score from Positive and Negative Syndrome Scale (PANSS), cholesterol LDL, subjective well-being under neuroleptic, Simpson–Angus Scale (SAS) delta scores, drug dosage and premorbid intelligence entered in the equation. These results suggest that indexes such as cognition, metabolic status, other than symptoms, have to be taken into account in order to refine the short-term remission prediction.     

Remission and cognitive ability in a cohort of patients with schizophrenia

INTRODUCTION: Patients with schizophrenia were studied regarding their ability of achieving symptomatic remission. It was found that only approximately one-third of the patients fulfilled the criteria for remission. The importance of cognitive performance was studied to decide whether cognitive ability is a contributing factor for achieving remission. MATERIALS AND METHODS: A homogeneous cohort of 211 patients, of whom 76 patients attained remission (36%), and 135 patients (64%) failed to, was studied. Remission was decided by the use of eight items from the PANSS in which none of these items should have a score above three points. The patients were also tested on a comprehensive battery of cognitive tests including vigilance, working memory, long-term memory, executive functioning, learning performance, visuomotor speed/efficacy, cognitive flexibility and pre-morbid functioning. RESULTS: Marked differences were exhibited in the cognitive abilities in all domains of patients who had attained remission in comparison with those who had not. DISCUSSION: This study highlights the importance of cognitive performance as one possible predictor of remission. Patients without remission had lower cognitive ability and may have more difficulty in benefiting from, or complying with their treatment. As a consequence, various forms of supportive treatment might increase the likelihood of remission.     

随机对照研究比较喹硫平与氟哌啶醇治疗精神分裂症的疗效

目的研究喹硫平对精神分裂症患者认知功能及生活质量的改善作用。方法将62名住院或门诊的急性期精神分裂症患者随机分为两组,分别给予喹硫平（n=32）和氟哌啶醇（n=30）治疗,随访16周。分别在基线、第8周、第12周和第16周用阳性与阴性综合征量表（PANSS）、生活质量和满意度自评问卷（Q-LES-Q）、持续性操作测验（CPT）、威斯康星卡片分类测验（WCST）以及成人韦氏智力量表（WAIS）中的数字广度项目盲法评定精神症状、生活质量和满意度以及认知功能。采用重复测量的方差分析比较两组结果。结果喹硫平组有17例完成16周的随访,氟哌啶醇组为14例。喹硫平组与氟哌啶醇组各时点PANSS评分均比基线改善,组间无明显差异。喹硫平组的4个时点平均（标准差）Q-LES-Q得分改善[分别为：49.0（8.1）分,51.2（7.0）分,54.3（10.6）分,54.1（10.3）分,F=11.70,P〈0.001],而氟哌啶醇组无明显改善[分别为：49.5（7.8）分,51.3（8.0）分,50.0（8.7）分,50.5（8.9）分;F=0.33,P=0.701]。在第16周时喹硫平组Q-LES-Q得分高于氟哌啶醇组（t=2.27,P=0.026）。第8周至第16周,喹硫平组WCST完成分类数、CPT的反应时间、WAIS数字广度评分与基线比均明显改善,而氟哌啶醇组的不同时点间评分无明显差异。结论虽然根据PANSS结果,急性精神分裂症患者用喹硫平和氟哌啶醇治疗的疗效相当,但是持续用喹硫平治疗16周者比持续用氟哌啶醇治疗者的生活质量更好,认知缺陷更少。     

A comparative study on quality of life of patients of schizophrenia with and without depression

Depression in schizophrenia has been recognized as one of the important factors influencing the Quality of Life (QOL). For this study 60 patients with a clinical diagnosis of schizophrenia as per ICD-10 (DCR version) were divided into two groups (with and without depression) on the basis of their score on Calgary Depression Rating Scale for Schizophrenia (CDSS). Thereafter, all patients were assessed on Positive and Negative Syndrome Scale for Schizophrenia (PANSS) for psychopathology, on Lehman Quality of Life Interview (QOLI)-brief version for QOL, on World Health Organization Disability Assessment Schedule-II (WHODAS-II) for disability, on UKU Side Effect Rating Scale for side effects of drugs and on Social Support Questionnaire (SSQ) for perceived social support. The two (depressed and non-depressed schizophrenia) groups differed significantly on symptoms of general psychopathology of PANSS and disability as per WHODAS-II, with the depressed group scoring higher. In the total sample, positive symptoms and the symptoms of general psychopathology of PANSS had a strong negative correlation with all three (subjective, objective and combined) domains of QOL, whereas, disability and medication side effects had a negative correlation with subjective and combined domains of QOL. CDSS total score did not significantly correlate with QOL. General psychopathology symptoms of PANSS emerged as the sole significant predictor of subjective and combined QOL, while positive symptoms of PANSS emerged as the sole predictor of objective QOL. Hence, it can be concluded that general psychopathology on PANSS had significant effect whereas depression as rated on CDSS had no significant effect on QOL in patients with schizophrenia. Treatments to improve QOL in schizophrenia should focus on symptoms of general psychopathology of PANSS.     

奥氮平与齐拉西酮对精神分裂症患者生活质量影响的对照研究

目的比较奥氮平与齐拉西酮对精神分裂症患者的社会功能和生活质量的影响。方法将64例精神分裂症患者随机分为两组,口服奥氮平组及口服齐拉西酮组,于治疗前及出院后3、6、12个月末采用PAN-SS、TESS、WHOQOL-100及SDSS评定。结果 3、6、12个月末随访,两组PANSS总分及各因子分均较治疗前显著下降(P<0.01);同期两组之间总分及各因子分比较无显著性差异(P>0.05)。两组WHOQOL-100躯体功能、心理功能、独立性、社会关系、生活质量总评因子分均较治疗前显著提高(P<0.01),同期两组之间总分及各因子分比较无显著性差异(P>0.05)。两组SDSS的婚姻职能、社会性退缩、家庭外的社会活动、家庭内活动过少、家庭职能、个人生活自理、对外界的兴趣和关心7个因子分均显著低于治疗前(P<0.01),同期两组之间各因子分比较无显著性差异(P>0.05)。奥氮平组不良反应发生率为44.1%(15/34),齐拉西酮组不良反应发生率为46.7%(14/30),两组间比较差异无显著性(P>0.05)。结论奥氮平和齐拉西酮均能提高精神分裂症患者的生活质量。     

氯丙嗪与齐拉西酮对精神分裂症患者生活质量影响的对照研究

目的探讨药物对精神分裂症患者生活质量的长期影响。方法采用生活满意度量袁（LSR）、社会功能缺陷筛选量表（SDSS）、阳性症状和阴性症状评定量表（PANSS）、副反应量表（TESS）对山东省临沂市精神卫生中心符合中国精神障碍分类与诊断标准的使用氯丙嗪或齐拉西酮治疗获临床治愈或显著进步的门诊、住院精神分裂症患者128例进行评定。结果齐拉西酮组两次TESS评分低于氯丙嗪组,差异有显著性（P〈0．01）,齐拉西酮组患者LSR量表各因子分愿望与已实现、热情与冷漠、自我评价、心境差异有显著性（t=2．455～3．341,P〈0．05）高于氯丙嗪组;氯丙嗪治疗组患者家庭外社会活动、家庭内活动过少、婚姻职能、社会退缩、对外界兴趣缺陷程度显著高于齐拉西酮治疗组患者（t=2．869～3．181,P均〈0．01）,个人生活自理、责任心和计划性的缺陷程度高于齐拉西酮治疗组（t=2．153,2．30,P均〈0．05）。多元逐步回归分析显示生活满意度与药物副反应、阴性症状得分成负相关（r=-0．238,-0．211）。结论与氯丙嗪相比服齐拉西酮的精神分裂症患者的生活质量较好,患者主客观生活满意度与药物副反应呈负相关。     

社区干预对精神分裂症患者社会功能及生存质量的影响

目的探讨以患者为中心的“患者-家属-社区居民”模式的社区干预对精神分裂症患者社区康复的影响。方法将精神分裂症患者随机分成干预组和对照组,对干预组患者及其家属、社区居民实施群体干预和个别指导,对照组只给予一般健康指导,共干预1年。采用家庭社会关怀度指数问卷（APGAR）、社会功能缺陷量表（SDSS）和生活质量综合评定问卷（GQOL1～74）对干预效果进行评定。结果实施干预后,干预组患者的社会功能缺陷程度明显降低,与干预前及两组间比较,均有显著性意义（P〈0．01）。患者得到较多的家庭、社会支持,家庭社会关怀度显著提高（P〈0．01）。患者生活质量与家庭社会支持度的相关性分析,除物质生活维度,其余3个维度即躯体功能（r=0．34、P〈0．01）、心理功能（r=0．36P〈0．01）、社会功能（r=0．28,P〈0．05）均与家庭社会关怀度呈正相关,患者生活质量明显提高（P〈0．01）。结论及时的社区干预可有效提高精神分裂症患者的社会功能和生活质量。     

精神分裂症患者生活质量研究进展

精神分裂症是严重危害人类健康的最常见的重性精神疾病之一.随着医学模式的转变及健康观念的不断完善,精神分裂症的治疗目标不仅仅是缓解症状、降低复发率,更重要的是促进个体在躯体、心理、社会功能诸多方面达到良好状态,即注重患者生活质量的改善.     

Dyspepsia and constipation in patients with schizophrenia spectrum disorders

Constipation and dyspepsia are disturbing gastrointestinal symptoms that are often ignored in research on physical comorbidities of schizophrenia. The aim was to assess dyspepsia and constipation in a sample of outpatients with schizophrenia spectrum psychoses. A general practitioner performed a thorough physical health check for 275 outpatients and diagnosed constipation and dyspepsia. This study assessed the possible contribution of several sociodemographic, lifestyle, and clinical variables to constipation and dyspepsia using logistic regression analysis. This study also assessed whether these symptoms were associated with abnormal laboratory findings. The prevalence of constipation was 31.3%, and of dyspepsia 23.6%. Paracetamol (OR =3.07, 95% CI =1.34–7.02) and clozapine use (OR =5.48, 95% CI =2.75–10.90), older age (OR =1.04, 95% CI =1.01–1.06), and living in sheltered housing (OR =2.49, 95% CI =1.16–5.33) were risk factors for constipation. For dyspepsia the risk factors were female sex (OR =2.10, 95% CI =1.15–3.83), non-steroidal anti-inflammatory drugs (OR =2.47, 95% CI =1.13–5.39), and diabetes medication (OR =2.42, 95% CI =1.12–5.25). Patients with dyspepsia had lower haemoglobin and haematocrit and higher glucose values than those without dyspepsia. Patients with constipation had lower thrombocyte values than patients without constipation. However, these findings were explained by factors pre-disposing to constipation and dyspepsia. Clozapine use markedly increases the risk of constipation and may lead to life-threatening complications. In addition, analgesics and diabetes medication were related to gastrointestinal symptoms. These medications and their association to gastrointestinal symptoms should be kept in mind when treating patients with schizophrenia.     

开放式与封闭式病房精神分裂症患者生存质量的比较

目的探讨开放式与封闭式病房模式对精神分裂症患者生存质量的影响。方法按入组标准选取我院开放式病房精神分裂症患者38例,封闭式45例。采用世界卫生组织生存质量评定量表（WHO QOL-100）、简明精神评定量表（BPRS）评定,并进行对比研究。结果开放式病房中的精神分裂症患者的生理领域、心理领域等WHO QOL-100评分高于对照组。结论开放式病房中的精神分裂症患者生存质量高于封闭式病房中的精神分裂症患者生存质量。     

慢性住院精神分裂症的生活质量及其相关因素研究

目的探讨慢性住院精神分裂症患者的生活质量及其相关因素。方法90例住院患者都采用生活质量量表、汉密顿焦虑量表及汉密顿抑郁量表检测,并比较各项数据。结果根据男性与女性患者之间的检测数据,在生活质量量表的各项目中的PF分值差异具有统计学意义(P<0.05);而RP、SF、RE的分值差异则呈现显著的统计学意义(P<0.01)。因此,上述结果提示男性患者生活质量的部分主要项目比女性好。另一方面,在较好家庭与较差家庭支持之间,焦虑量表与抑郁量表的总分值之间,都呈现显著的统计学意义,这也提示抑郁和焦虑情绪在较好家庭支持时可能有所减少。结论尽最大努力促进生活质量中的主项如PF、RP、SF、RE以及家庭支持等,能改善慢性住院精神分裂症患者的康复效果。