儿童精神分裂症患者的预后及相关因素分析

The prognosis and the related factors of childhood schizophrenia

目的 探讨儿童精神分裂症的预后及其影响因素。方法 收集1987-1997年首次住院的儿童（起病年龄≤14岁）精神分裂症患者（儿童组）124例和同期首次住院的成人（起病年龄25～30岁）精神分裂症患者（成人组）120例，采用社会功能缺陷量表（SDSS）、日常生活能力量表（ADL）、大体评定量表（GAS）及自制调查表，以随访与量表现场测评相结合的方法获得资料，数据采用多因素回归分析。结果 （1）儿童组服药依从性（90例，77．6％）好于成人组（73例，64．0％；χ^2=5．11，P〈0．05）；复发率（29．3％）低于成人组（42．1％；χ^2=4．10，P〈0．05）。（2）儿童组预后良好者（91例，78．4％）显著多于成人组（65例，57．0％）。（3）儿童组的社会功能[（2．11±1.02）分]和日常生活能力[（18．78±9．17）分]优于成人组[（3．48±1．86）分和（21.82±8．67）分；P〈0．01和P〈0．05]。（4）经多因素回归分析，影响儿童精神分裂症预后的主要因素有：社会家庭关爱程度，首次住院疗效，起病形式，服药时间和病期（P〈0．01）。结论 儿童精神分裂症患者总体预后较好；充分的家庭关爱，首次住院疗效好，急性起病，坚持长期治疗和病期较短者的预后更好。

Objective To explore the prognosis and the related factors of childhood schizophrenia. Methods The subjects with schizophrenia who were in hospitalization from 1987 to 1997 were followed up until December, 2003. All 124 childhood schizophrenia with the age of onset of ≤ 14 years and 120 adulthood schizophrenia with the age of onset of 25-30 years were included. The subjects were evaluated with the Global Assessment Scale （ GAS）, Social Disability Screening Schedule （ SDSS）, Activity of Daily Living Scale （ADL） and a self-compiled questionnaire. The data were analyzed with t-test, the chisquare test and multiple factor regression. Results The children group had better compliance to treatment （77. 6% vs. 64. 0% ; χ^2 =5. 11, P 〈0. 05）, and lower recurrence rate （29.3% vs. 42. 1% ; χ^2 =4. 10, P 〈 0. 05） than the adult group. The rate of eusemia was significantly higher in children group （78.4%） than that in adult group （57. 0% ）. The children had better social function （ 2. 11 ± 1.02） and activity of daily living （18.78 ±9.17） than adult group [ （3.48 ±1.86） and （21.82 ±8.67） ]. Multiple regression analysis showed that the related factors to prognosis of childhood schizophrenia were degree of society support, efficacy of first hospitalization, pattern of onset, therapy time and illness duration （P 〈 0. 01 ）. Conclusion Childhood schizophrenia may have better prognosis than adult schizophrenia, and the family support, better therapeutic effect in the first hospitalization, acute onset, long-term therapy compliance, and shorter illness duration are associated with better prognosis.