难治性精神分裂患者自行中断治疗的影响因素分析

Analysis of influencing factors of self-interrupting treatment in patients with treatment-resistant schizophrenia

目的分析难治性精神分裂(TRS)患者自行中断治疗的发生率及其影响因素。方法选取2017年1月至2019年11月本院收治的648例TRS患者作为研究对象,以完成规定疗程治疗或自行中断治疗为终点事件。分析自行中断治疗发生率,单因素与多因素Logistic回归分析TRS患者自行中断治疗的影响因素。结果最终纳入639例TRS患者,采纳率为98.61%;其中自行中断治疗133例(中断组),自行中断治疗发生率为20.81%;未中断治疗506例(未中断组)。中断组与未中断组居住地、文化程度、工作状态、家庭月收入、结算方式、病程、临床分型、家族史、合并症、住院次数、氯氮平用药时间、抗精神病药物种类、是否联合改良电抽搐治疗/电抽搐治疗(mECT/ECT)、阳性和阴性精神症状评定量表(PANSS)减分率、临床总体印象-疾病严重程度量表(CGI-S)评分、社会功能缺陷筛选量表(SDSS)评分、社会支持评定量表(SSRS)评分、治疗副反应量表(TESS)、精神卫生知识掌握情况、用药知识掌握情况及规范心理辅导比较差异有统计学意义(P<0.05)。Logistic回归分析结果显示,TESS中行为毒性、住院次数多、病程长、氯氮平用药时间长、抗精神病药物种类多是TRS患者自行中断治疗的危险因素(OR>1,P<0.05);用药知识掌握很好、规范心理辅导、SSRS评分高、PANSS减分率高是TRS患者自行中断治疗的保护因素(OR<1,P<0.05)。结论病程的迁延难愈、氯氮平用药时间延长、治疗过程中药物相关的行为毒性及住院次数和抗精神病药物种类增多是TRS患者自行中断治疗的主要危险因素,重视患者用药知识水平的指导与教育,规范TRS患者治疗过程中的心理辅导与社会支持干预对降低TRS患者自行中断治疗,提高依从性具有积极作用。

Objective To analyze the incidence of self-interrupting treatment in patients with treatment-resistant schizophrenia(TRS)and its influencing factors.Methods 648 TRS patients admitted to our hospital from January 2017 to November 2019 were selected as the research subjects,with the completion of the prescribed course of treatment or self-interrupting treatment as the end-point events.The incidence of self-interrupting treatment was analyzed,and the influencing factors of self-interrupting treatment in TRS patients were analyzed by univariate and multivariate Logistic regression.Results A total of 639 patients with TRS were finally included,and the acceptance rate was 98.61%,of which 133 cases of self-interrupting treatment(interrupted group),and the incidence of self-interrupting treatment was 20.81%;506 cases were treated without interruption(noninterruption group).There were statistically significant differences between the interrupted group and the non-interrupted group in terms of residence,educational level,work status,family monthly income,settlement method,duration of disease,clinical classification,family history,comorbidities,number of hospitalizations,duration of clozapine medication,types of antipsychotic drugs,whether combined with modified electroconvulsive therapy/electroconvulsive therapy(mECT/ECT)treatment,positive and negative syndrome scale(PANSS)score reduction rate,clinical global impression scale(CGI-S)score,social disability screening schedule(SDSS)score,social support rating scale(SSRS)score,treatment emergent symptom scale(TESS),mental health knowledge mastery,medication knowledge mastery and standardized psychological counseling(P<0.05).Logistic regression analysis showed that behavioral toxicity,more hospitalizations,lunger duration of disease,lunger duration of clozapine medication,and more types of antipsychotic drugs were risk factor for self-interrupting treatment in TRS patients(OR>1,P<0.05).The good medication knowledge,standardized psychological counseling,high SSRS score and high PANSS score reduction rate were the protective factors for self-interrupting treatment in TRS patients(OR<1,P<0.05).Conclusion The prolonged disease course,the prolonged administration time of clozapine,the drug-related behavioral toxicity during the treatment,the number of hospitalizations and the increase in the types of antipsychotic drugs are the main risk factors for TRS patients to discontinue treatment on their own,and pay attention to patient knowledge level guidance and education,and standardizing the psychological counseling and social support interventions during the treatment of TRS patients have a positive effect on reducing the self-interruption of treatment by TRS patients and improving compliance.