早发性精神分裂症治疗效果不佳的相关因素分析

Analysis of factors related to poor curative effect of early-onset schizophrenia

目的:通过与非难治性精神分裂症患者生物学与社会心理部分计量指标和记数指标的对比,了解早发性精神分裂症治疗效果不佳的主要相关因素。方法:纳入2001-1/2003-12在深圳市康宁医院重性精神病区住院的难治性精神分裂症中早发性精神分裂症(首次发病年龄小于或等于18岁)患者40例,入观察组;对照组则按照与观察组1∶1的比例,分别在不同性别的、首次发病年龄小于或等于18岁的非难治性精神分裂症患者中随机选取。采用自行设计记录表,项目包括一般资料、文化程度、精神病家族史(阴性、阳性)、首次发病年龄、病前性格(内向、外向)、有无诱因、病前1年的社会功能、起病形式(急性、亚急性、慢性)、治疗前病程(首发精神异常至接受治疗时间间隔)、总病程、住院次数、病程特点(间歇性、持续性)、症状特点(阴性为主、阳性为主)、治疗依从性、社会支持系统等。其中病前1年的社会功能、治疗依从性及社会支持系统3个项目分为差、较差、一般、较好、好5个等级,统计时分别设定为5～1分。比较两组患者的阳性与阴性症状量表减分率,一致性检验Kappa=0.88;并分析自行设计记录表中各指标与早发性精神分裂症难治的关系。采用t检验,χ2检验及二项Logistic回归分析中的Forward-LR法,差异性水平为0.05。结果:观察组与对照组共80例进入结果分析,无脱落者。①难治性分裂症中,早发性比率为35.40%。92.5%的患者慢性起病,87.5%的患者为持续性病程;②观察组病前1年的社会功能、总病程、住院次数、治疗依从性、社会支持5项计量指标得分均显著高于对照组[3.37±0.77,2.73±0.45;(112.80±77.65),(52.23±61.82)个月;4.03±3.61,1.95±1.36;3.78±0.73,2.78±0.89;3.30±1.18,2.03±0.73;t=3.40～5.80,P<0.001]。③观察组在文化程度、起病形式、病程特点、症状特点上与对照组差异显著(初中及以下:32/80.0%,20/50.0%;高中中专:7/17.5%,20/50.0%;大学及以上:1/2.5%,0;急性:2/5.0%,9/22.5%;亚急性:1/2.5%,11/27.5%;慢性:37/92.5%,20/50.0%;间歇性:5/12.5%,18/45.0%;持续性:35/87.5%,5/12.5%;首次发病:0,17/42.5%;阴性为主:4/10.0%,0;阳性为主:36/90.0%,40/100.0%;χ2=10.3,17.86,44.21,4.21,P<0.05)。④二项Logistic回归分析显示,早发性精神分裂症是否难治的影响因素依次为治疗依从性、病前1年社会功能、性别、社会支持(11.13,8.53,7.20,5.80,P<0.05,R2=0.756)。结论:早发性精神分裂症是否难治,既有生物学的因素,也有社会心理因素的影响,在药物治疗的同时,要注意加强依从性教育和社会支持,促进社会功能的恢复。

AIM： To comprehend the main associated factor of bad curative effect of early-onset schizophrenia through the comparison of biology and indicator and numerable index of social psychology with non-treatment-resistant schizophrenia patients. METHODS： Forty patients with early-onset schizophrenia （age of first episode was less than or equal to 18 years） in treatment-resistant schizophrenia, who were hospitalized at the major psychosis area of Shenzhen Kangning Hospital between January 2001 and December 2003, were selected into the observation group. Based on different sex, age of first episode was less than or equal to18 years in the non-treatment-resistant patients in the control group and the observation group were selected randomly according to the proportion of 1 to 1. Using self-made log scale, the item included general data, cultural education, family history of psychosis （negative, positive）, age of first episode, character before ill （introversion, extroversion）, with or without inducement, social function one year before ill, pattern of episode （acute, sub-acute, chronic）, progress pre-treatment （interval from first abnormal psyche to time of accepting therapy）, length of illness, frequency of hospitalization, feature of progress （intermission, durative）, characteristics of symptom （mainly negative, mainly positive）, compliance of therapy and system of social support, etc. Social function, compliance of therapy and system of social support were presented as 5 grades： bad, comparatively bad, general, comparatively good, good one year before ill, setting 5-1 points. Reduction rates of positive and negative symptom scale in patients of the two groups were compared, consistency checking Kappa=0.88. Relationship between every index in the self-made log scale and treatment-resistance early-onset schizophrenia was analyzed. T-test, χ^2 test and Forward-LR of bilogistic regression analysis were adopted. The level of difference was 0.05. RESULTS： Totally 80 patients in the observation group and control group were involved in the result analysis, without drop-out. ①In the.treatment-resistant schizophrenia, the rate of early-onset schizophrenia was 35.40%. 92.5% patients were chronic episode, and 87.5% patients were continuous progress. ②The scores on social function, length of illness, frequency of hospitalization, compliance of therapy and social support were all higher significantly in the observation group than those in the control group one year before ill [3.37 ±0.77,2.73 ±0.45 ; （ 112.80±77.65）, （52.23 ±61.82） months;4.03 ±3.61,1.95 ±1.36;3.78 ±0.73,2.78±0.89;3.30 ±1.18,2.03 ±0.73;t=3.40-5.80,P 〈 0.001]. ③The cultural education, pattern of episode, feature of progress and characteristics of symptom in the observation group differed significantly from those in the control group （below middle school：32/80.0% ,20/50.0% ;high school and secondary technical school ： 7/17.5% , 20/50.0% ; above university ： 1/2.5% , 0; acute ： 2/5.0%, 9/22.5% ; sub-acute ： 1/2.5%, 11/27.5% ; chronic ： 37 /92.5%, 20/50.0% ; intermission：5/12.5% ,18/45.0% ;durative：35/87.5% ,5/12.5% ;first episode ：0,17/42.5% ; mainly negative ：4/10.0% , 0 ; mainly positive ： 36/ 90.0%,40/100.0%;χ^2=10.3,17.86,44.21,4.21, P 〈 0.05）. ④ Bilogistic regression analysis showed that influence factor of whether treatment-resistant or not of early-onset schizophrenia was compliance of therapy, social function one year before ill, sex and social support in order （11.13,8.53, 7.20,5.80,P 〈 0.05,R^2=-0.756）. CONCLUSION： Whether early-onset schizophrenia treatment-resistant or not, which is related to biologic factor and social psychological factor. At the same time of drug treatment, compliant education and social support should be strengthened, and recovery of social function should be accelerated.