Costs of Schizophrenia at Psychiatric Hospital of Bingerville (Ivory Coast)

Schizophrenia is classified as a priority mental disorder by the World Health Organization (WHO) and accounts for around 35% of diagnoses at the Bingerville Psychiatric Hospital (HPB). The aims of the study were to identify the cost drivers for hospitalization and to calculate the costs of managing schizophrenia in hospital, with a view to planning household expenditure on care. This pilot cross-sectional study involved 31 patients with schizophrenia who had been hospitalized in the various third-category wards at the HPB between 1st January 2019 and 31st May 2020. Sampling was accidental. The methods used to estimate costs were based on the actual costs of drugs, hospitalization and additional examinations which prices were known, and on patients’ estimations for certain expenses such as food and transport. Results: The sex ratio was 3.42, the mean age was 29.52 years. The mean length of stay was 46.19 days, and the most frequent clinical forms were paranoid schizophrenia (41.9%) and schizoaffective disorder (29%). The combination of haloperidol and chlorpromazine was the most common medications for initial treatment (67.8%) and maintenance treatment (41.9%). The average cost of hospitalization at HPB for schizophrenia was XOF 164,412 (€249.90). The average direct medical cost was XOF 105,412 (€160.226) and the average direct non-medical cost was XOF 59,000 (€89.68). The average daily cost of antipsychotic treatment was XOF 795/day (€1.2084). The high cost of drugs as a proportion of hospitalization costs suggested the need of a reflection on the simplification of prescribing practices, assistance in psychiatric emergencies and the development of other alternatives to psychiatric hospitalization in Côte d’Ivoire.

Wendan decoction improves learning and memory deficits in a rat model of schizophrenia

An experimental model of schizophrenia was established using dizocilpine （MK-801）. Rats were intragastrically administered with Wendan decoction or clozapine for 21 days prior to establishing the model. The results revealed that the latency of schizophrenia model rats to escape from the hidden platform in the Morris water maze was significantly shortened after administration of Wendan decoction or clozapine. In addition, the treated rats crossed the platform significantly more times than the untreated model rats. Moreover, the rate of successful long-term potentiation induction in the Wendan decoction group and clozapine group were also obviously increased compared with the model group, and the population spike peak latency was significantly shortened. These experimental findings suggest that Wendan decoction can improve the learning and memory ability of schizophrenic rats to the same extent as clozapine treatment.

Prevalence and associated factors of suicide among hospitalized schizophrenic patients

BACKGROUND Previous studies found several factors associated with suicide in schizophrenic patients,such as age,sex,education level,history of suicide attempts,psychotic symptoms,social factors,and substance abuse.However,there might be some additional factors that were not considered in previous studies but may be correlated with a greater likelihood of suicide attempts,such as medication and treatment.AIM To investigate the prevalence of suicide attempts and identify the risk of suicidality in hospitalized schizophrenia patients.METHODS This is a cross-sectional study of schizophrenic patients admitted to a psychiatric hospital who were 18 years of age or more.The outcomes and possible suicide risk factors in these patients were collated.The current suicide risk was evaluated using the mini-international neuropsychiatric interview module for suicidality and categorized as none(0 points),mild(1-8 points),moderate(9-16 points),or severe(17 or more points).This study used ordinal logistic regression to assess the association of potential risk factors with the current suicide risk in schizophrenic patients.RESULTS Of 228 hospitalized schizophrenia patients,214(93.9%)were included in this study.The majority(79.0%)of patients were males.Females appeared to have a slightly higher suicidality risk than males,with borderline significance.With regard to the current suicide risk assessed with the mini-international neuropsychiatric interview,172(80.4%)schizophrenic patients scored zero,20(9.4%)had a mild risk,8(3.7%)had a moderate risk,and 14(6.5%)had a severe risk.The total prevalence of current suicide risk in these schizophrenic patients was 19.6%.Based on multivariable ordinal logistic regression analysis with backward elimination,it was found that younger age,a current major depressive episode,receiving fluoxetine or lithium carbonate in the previous month,or a relatively higher Charlson comorbidity index score were all significantly and independently associated with a higher level of suicide risk.CONCLUSION The prevalence rate of suicide attempts in schizophrenia is high.Considering risk factors in routine clinical assessments,environmental manipulations and adequate treatment might prevent or decrease suicide in these patients.

Predictors of Discontinuation of Antipsychotic Therapy in Patients with Acute Schizophrenia: A 1-Year Observational Study with More Than 1000 Patients

Discontinuation of antipsychotic therapy has been a significant clinical issue among patients with schizophrenia, since the patients who discontinued antipsychotic treatment showed worse clinical and functional outcomes, and higher risks of relapse of schizophrenia symptoms and hospitalization. We conducted a post-hoc analysis of a post-marketing research with a 12-month follow-up period to identify the predictors for discontinuation of antipsychotic monotherapy in Japan. This is a prospective, naturalistic multicenter observational study, designed to evaluate the discontinuation rates of olanzapine monotherapy and non-olanzapine antipsychotic monotherapy in Japanese adult patients with acute schizophrenia. Patients were treatment-naive, or had switched from other antipsychotics or from poly-pharmacotherapy to oral antipsychotic monotherapy. We analyzed the correlation of discontinuation of antipsychotic monotherapy with baseline characteristics of patients. A total of 1089 patients (578 patients treated with olanzapine and 511 with non-olanzapine antipsychotics) were eligible for analysis. By the end of the 12-month study period, 614 patients (56.4%) discontinued antipsychotic therapy. Multivariate logistic regression analyses indicated significantly lower discontinuation rates in all patients treated with antipsychotics: older age (Odds ratio [OR], 0.871;95% confidence interval [CI], 0.797 to 0.953;p = 0.003), outpatient status (OR, 0.508;95% CI, 0.383 to 0.675;p < 0.001), prior use of antipsychotics (OR, 0.693;95% CI, 0.516 to 0.930;p = 0.015), and olanzapine group showed lower discontinuation rate than that of non-olanzapine group (OR, 1.416;95% CI, 1.086 to 1.846;p = 0.010). The present study indicated that the outpatient status, older age, and prior use of antipsychotics have better adherence to antipsychotic treatment. In addition to these factors, use of anti-parkinson agents showed lower discontinuation rates in the olanzapine monotherapy group.

Schizophrenia and Other Psychoses in Polish Middletown

The most of studies conducted up till now have shown a frequent occurrence of schizophrenia and other psychoses in cities compared to rural and suburban areas. The following research work was done on the basis of address data in a medium size town of people placed in psychiatric hospitals schizophrenia and other psychoses in the years 1989-2002. ICD9 criteria were initially used for hospital diagnosis, and then ICD10 criteria. To study the differences among particular districts of the town the test for two proportions was conducted. The analyzed group of persons amounted to 380 patients, including 169 men and 211 women. It indicated that patients more frequently lived in more urbanized and postindustrial districts of town as well as men aged 20-29 years old in postindustrial districts. It should be mentioned that more of patients placed the inner city, but also in postindustrial district and in districts with city housinz oroiects.

Long-Term Clinical Outcome of Patients Using Risperidone Long-Acting Injectable: The Romanian e-STAR Database

The objectives of e-STAR Romania (NCT00283517) were to collect clinical outcome data of Romania schizophrenia or schizo-affective disorder patients;prospectively to assess the reasons of treatment initiation, medication usage patterns;to document (long-term) clinical efficacy;and to collect safety data, as well as recording 2-year corresponding retrospective data. In total, 378 eligible subjects were enrolled who were initiated either on risperidone long-acting injectable (RLAI) (290) or on an oral antipsychotic (OA) (88) at baseline as required by the local Summary of the Product Characteristics. Data were collected from per patient both retrospectively and prospectively over a 24-month period at 3-month intervals after starting treatment. The results indicated that subjects suffering from schizophrenia or schizo-affective disorder initiated on RLAI were less likely to be hospitalized within the first 24 months after the initiation of treatment. Moreover, subjects treated with RLAI experienced significant improvements in their illness severity and functioning. Discontinuation rates for RLAI were low and doses were stable throughout the 24 months following the initiation of treatment. In addition, the necessity for supplementary concomitant medication was reduced. Adverse events were reported in 20.3% (RLAI) and 11.4% (OA) of the subjects. In general, patients initiated on RLAI and OA at baseline both clinically improved on all assessed parameters but a larger improvement was observed for patients on RLAI. Incidences of reported AEs during the use of RLAI in a naturalistic setting are comparable with those described in clinical studies;however, the incidence of extrapyramidal signs and weight gain was lower than expected.

The study of the opening-up rehabilitation to the inpatients with chronic schizophrenia

Objective To investigate the opening-up rehabilitation to the inpatients with chronic schizophrenia .Methods We carried out the rehabilitation opening-up in the hospital to 40 inpatients with chronic schizophrenia from 1990 to 1995. We regulated carefully , respected the personality and lawful rights of the patients , set up the equality between the medical staff and patients , evaluated according to their achievements, took the keeping-watch nursery to the patients with severe condition .No accident happened in the study. Results The social function and negative symptoms of most patients improved greatly. Medicine treatment with maintenance dosage is the basic grantee of the safe rehabilitation . The treatment of working can let the patients regain the skill of working and study .The treatment of entertainment can relaxed ,dredged their emotion and stimulated them .The treatment of reading can increase the knowledge of patients .The patients can recognize and solve their own problems by reading. So, it has educational function. The individual or group psychological therapy can eradicate the disturbance of psychology and emotion of the patients .Conclusions It is effective by carrying out rehabilitation opening-up in the hospital to the inpatients with chronic schizophrenia .

奥尔夫音乐疗法对精神分裂症长期住院患者干预研究

目的探究对精神分裂症长期住院患者进行奥尔夫音乐治疗是否有促进康复的效果。方法在2023年4月至2023年9月开展随机、单盲、对照试验,纳入68例长期住院精神分裂症患者,随机分为研究组和对照组,每组各34例。研究组在维持原有药物、常规康复治疗基础上增加奥尔夫音乐治疗,对照组仅维持原有药物和常规康复治疗,干预8周。在基线和干预后,对两组患者分别进行阳性与阴性症状量表(positive and negative syndrome scale,PANSS)、住院精神病人康复疗效评定量表(inpatient psychosis rehabilitation observe scale,IPROS)、个人和社会功能量表(personal and social performance scale,PSP)评估。结果在治疗前,两组PANSS、IPROS、PSP得分对比未见统计学差异(均P>0.05)。干预8周后,PANSS量表显示:研究组治疗前后的评分差值在阴性症状(-3.20±4.13vs.-0.17±2.43,P<0.001)、一般症状(-2.79±3.83 vs.-0.17±2.99,P=0.003)、总分(-5.88±6.36 vs.0.00±4.08,P<0.001)指标上优于对照组,而在阳性症状上的差异无统计学意义(P>0.05)。IPROS量表显示:研究组患者在参与工疗情况(-0.82±2.08 vs.0.23±2.10,P=0.041)、社交能力(-0.59±1.94 vs.0.53±1.69,P=0.014)和生活能力(-0.94±2.50 vs.0.15±1.48,P=0.033)方面,干预前后的评分差值与对照组比较差异有统计学意义。PSP量表表明:研究组治疗前后的评分差值在社会活动[0(-1,0)vs.0(0,0),P=0.011]、自我照料[0(-1,0)vs.0(-0.25,0),P=0.012]上优于对照组。结论对于长期住院的精神分裂症患者,奥尔夫音乐疗法能有效缓解精神症状、促进社会功能、提升康复疗效。

长期住院精神分裂症患者血糖影响因素的研究

目的:探讨住院精神分裂症患者影响血糖代谢相关因素。方法:收集2019年1月1日至2021年12月31日期间1174例住院精神分裂症患者的性别、年龄、受教育程度、病程、高血压病史、使用抗精神病药物等相关资料,以2021年12月空腹血糖值分为血糖正常组和血糖异常组,收集患者2019年12月和2021年12月空腹血糖、尿酸、三酰甘油、总胆固醇、高密度脂蛋白及低密度脂蛋白等相关指标并分析。结果:整体血糖异常组和血糖正常组2021年血糖均高于2019年(P<0.05),血糖异常组更显著(Z=-2.800,P<0.05)。血糖异常组在年龄、病程、高血压患病率、氯氮平使用率、利培酮使用率、尿酸水平、三酰甘油水平均明显高于血糖正常组;血糖异常组在阿立哌唑使用率和高密度脂蛋白水平低于血糖正常组。三酰甘油水平、年龄、氯氮平、利培酮、高血压是2021年血糖的影响因素(P<0.05)。结论:三酰甘油水平、年龄、氯氮平、利培酮、高血压是住院精神分裂症患者发生血糖异常或者糖尿病的危险因素。

精神分裂症患者长期住院的影响因素

目的:分析精神分裂症患者长期住院的影响因素。方法:纳入我院318例精神分裂症患者,根据住院时间将其分为长期住院组(平均≥10个月/年)和对照组(平均<10个月/年)。采用单因素和多因素Logistic回归分析患者长期住院的独立影响因素,绘制列线图预测模型并进行内部验证。结果:318例精神分裂症患者中长期住院126例(39.62%)。多因素Logistic回归分析显示年龄、病程、公职人员、已婚、大专及以上学历、照料者是父母/配偶/子女、省/市医保付费以及有精神残疾证是精神分裂患者长期住院的独立影响因素(P均<0.05)。绘制列线图预测模型并进行内部验证得一致性指数(C-index)=0.803,区分度较好。结论:年龄、病程、职业、婚姻状态、文化程度、照料者和付费方式是精神分裂患者长期住院的独立影响因素,基于上述影响因素构建列线图预测模型可有效预测精神分裂患者的长期住院概率。

长期住院精神分裂症患者合并不同躯体疾患的发生率及影响因素研究

目的调查分析精神分裂症患者合并不同躯体疾患的发病率以及各项临床指标,探讨其影响因素,提高专科医生识别精神分裂症患者合并躯体疾患征的风险意识。方法选取2022年1月-2023年1月于该院接受长期住院治疗的60例精神分裂症合并躯体症状患者为研究组,以非躯体症状患者为对照组,共60例(病例配比为1∶1),统计患者一般资料及合并发生躯体疾病的情况,并分析影响躯体疾病的相关因素。结果经单因素分析结果显示:(1)研究组患者年龄≥50岁比例66.67%高于对照组43.33%,差异有统计学意义(χ^(2)=6.599,P<0.05);(2)病程分布方面,研究组病程≥5年患者比例75.00%显著高于对照组55.00%,差异有统计学意义(χ^(2)=5.275,P<0.05);(3)既往居住特征方面,研究组有流浪史患者比例81.67%显著高于对照组58.33%,差异有统计学意义(χ^(2)=7.778,P<0.05);(4)服药时间方面,研究组≥5年患者比例46.67%明显高于对照组25.00%,差异有统计学意义(χ^(2)=6.125,P<0.05);经logistic回归进一步证实,年龄、病程、流浪史及服药时间是躯体和疾病的影响因素。结论长期住院的精神分裂症患者的躯体疾病类型多样,普遍存在。患者的年龄、流浪史、病程及服药时间均会影响躯体疾病的发生,说明有必要进行多个方向的诊断,加强重视并积极进行有效防治,符合治疗原则。

院外延伸护理对稳定期精神分裂症患者自我效能及依从情况的影响

目的探讨院外延伸护理在稳定期精神分裂症患者中的应用效果。方法选择2023年3—8月本院100例稳定期精神分裂症患者,随机分为两组,各50例。常规组行常规护理及出院后随访,延伸组同时采用院外延伸护理。比较两组贝克抑郁量表第二版(BDI-Ⅱ)、焦虑自评量表(SAS)、简明精神病量表(BPRS)、精神分裂症患者生活质量量表(SQLS)、一般自我效能感量表(GSES)、Morisky用药依从性问卷(MMAS-8)。结果两组干预后BDI-Ⅱ、SAS、BPRS、SQLS评分均低于干预前,且延伸组低于常规组(P<0.05);两组干预后GSES、MMAS-8评分均高于干预前,且延伸组均高于常规组(P<0.05)。结论院外延伸护理能够促进稳定期精神分裂症患者不良情绪及精神病症状改善,提高患者自我效能及服药依从性,同时提高生活质量。

住院慢性精神分裂症患者跌倒的高危因素及防范措施分析

目的探讨住院慢性精神分裂症(SCH)患者跌倒的高危因素及防范措施。方法回顾性分析119例慢性SCH患者的临床资料,依据住院期间是否发生跌倒事件分为跌倒组与未跌倒组,收集两组年龄、性别、日常生活能力、平衡能力、病程等多方面基础资料进行单因素分析,将单因素分析中差异有统计学意义的因素开展多因素Logistic回归分析,获得影响跌倒的高危因素。结果119例患者共46例发生跌倒,跌倒发生率为38.66%(46/119)。两组性别、体质量指数(BMI)、吸烟史、饮酒史、文化程度、合并高血压比较,差异无统计学意义(P>0.05);跌倒组年龄≥60岁22例(47.83%)、合并糖尿病29例(63.04%)、合并冠心病24例(52.17%)、日常生活能力欠佳30例(65.22%)、平衡能力欠佳28例(60.87%)、病程≥10年32例(69.57%),未跌倒组年龄≥60岁19例(26.03%)、合并糖尿病22例(30.14%)、合并冠心病20例(27.40%)、日常生活能力欠佳20例(27.40%)、平衡能力欠佳22例(30.14%)、病程≥10年33例(45.21%),两组年龄、合并糖尿病、合并冠心病、日常生活能力、平衡能力、病程比较,差异有统计学意义(P<0.05)。将单因素分析中差异有统计意义的年龄、合并糖尿病、合并冠心病、日常生活能力、平衡能力、病程纳入多因素Logistic回归分析模型进行分析显示:年龄≥60岁[OR=2.605,95%置信区间=(1.195,5.682)]、合并糖尿病[OR=3.955,95%置信区间=(1.813,8.627)]、合并冠心病[OR=2.891,95%置信区间=(1.333,6.269)]、日常生活能力欠佳[OR=4.969,95%置信区间=(2.243,11.008)]、平衡能力欠佳[OR=3.605,95%置信区间=(1.661,7.823)]、病程≥10年[OR=2.771,95%置信区间=(1.271,6.040)]为住院慢性SCH患者跌倒的高危因素(P<0.05)。结论住院慢性SCH患者跌倒的高危因素包括年龄≥60岁、合并糖尿病、合并冠心病、日常生活能力欠佳、平衡能力欠佳、病程≥10年,需高度重视,并做好防范措施,降低跌倒风险。

精神分裂症巩固期患者康复的影响因素分析

目的探讨影响精神分裂症巩固期患者康复的因素。方法选取2019年3月—2022年2月在宜春市第三人民医院接受诊治的87例精神分裂症巩固期患者为研究对象。以巩固治疗6个月时简明精神病评定量表(BPRS)评分定义患者康复结局,BPRS≥35分即视为康复不良。使用Logistic回归分析精神分裂症巩固期患者康复的影响因素。结果本研究共收录87例达到巩固治疗期的患者,3例患者受认知障碍影响而没能完成问卷填写,1例反复填写有误,均导致回收无效,治疗期间2例产生暴力行为被强制控制,1例出院后失访,最终80例患者获得研究结果。80例患者BPRS评分为28.00(23.00,32.00)分,其中14例患者得分>35分,为康复不良组。单因素分析显示,康复不良组未治期婚姻、自杀史、社会化住院、自我怜悯评分(SCS)与康复良好组比较差异有统计学意义(P<0.05)。经Logistic回归分析,自我怜悯、自杀史、社会化住院是导致精神分裂症巩固期患者康复不良的主要影响因素,差异均有统计学意义(P<0.05)。结论影响精神分裂症巩固期患者康复结局的因素包括自我怜悯、自杀史、社会化住院,临床应重视影响患者康复的因素,采取干预措施,以促进患者康复。

长期住院老年精神分裂症患者抑郁症状调查分析

目的：对长期住院老年精神分裂症患者抑郁状况进行调查分析，了解其抑郁症状的发生情况及特点。方法对在北京回龙观医院长期住院老年精神分裂症患者60例（男、女各30例），用汉密尔顿量表（HAMD）进行评定，分析长期住院老年精神分裂症患者出现抑郁情绪的临床特点。结果长期住院老年精神分裂症患者抑郁症状发生率11.7%（男0%，女23.3%），女性抑郁症状的发生率高于男性。抑郁特征依照严重程度排列依次为阻滞、焦虑/躯体化、认知障碍、绝望感、睡眠障碍。结论长期住院老年精神分裂症患者合并抑郁症状不容忽视，应采取积极有效的治疗措施，必要时应予以药物治疗、心理治疗及康复治疗等综合治疗策略。

华人精神分裂症患者吸烟对住院次数和住院时间影响的Meta分析

目的:评价吸烟对华人精神分裂症患者住院次数(NHAs)和住院时间(LHS)的影响。方法:计算机检索中英文数据库,收集有关吸烟与非吸烟分裂症患者与NHAs和LHS对比的研究报道,按照匹配原则独立评价纳入研究的质量和进行数据提取。通过Meta分析计算吸烟和非吸烟患者NHAs和LHS的加权均数差(WMD)。结果:共计20项研究(包括2088例吸烟和1823例非吸烟分裂症患者)纳入Meta分析。吸烟患者的NHAs和LHS均显著高于非吸烟患者,其WMD分别为0.69(95%CI:0.43,0.96)和0.28(95%CI:0.10,0.46)。结论:吸烟可能导致华人分裂症患者NHAs增多和LHS延长。

影响3765例精神分裂症病人平均住院日的因素分析

目的通过对影响精神分裂症病人平均住院日的因素分析，探讨精神科平均住院日的制定标准及其缩短的措施。方法应用ＳＰＳＳ统计软件对１９９５～１９９７年内住院的３７６５例精神分裂症病人进行方差分析和逐步回归分析。结果影响精神分裂症病人平均住院日的因素，主要包括：婚姻、费用支付方式、住院次数、性别、职业、年龄、院内感染和并发症。结论以本地区出院病人资料为测算依据，并考虑到病种、病程、年龄因素的影响来分别核定平均住院日标准，是切实可行的；同时要加强对影响平均住院日的管理因素的控制，提高医疗质量。

参保精神分裂症患者住院费用结构分析

目的了解2003～2007年天津市参保精神分裂症患者住院费用的影响因素及发展态势,找出影响结构变动的主要费用项目及变动情况。方法运用新灰色关联分析法,对住院费用构成进行定量分析;采用结构变动度、结构变动值和结构变动贡献率等指标,分析5年中住院费用结构的变动情况。结果 5年来医保住院患者的医疗费用各项目在总体顺位上保持相对稳定。结果显示,治疗费是住院费用的主要影响因素,其次是检查费和床位费。5年住院医疗费用结构变动度为23.04%,年均结构变动度为5.76%。治疗费、检查费、床位费是引起住院医疗费用支出结构变动的主要费用项目,累积贡献率为77.91%。结论新灰色关联分析法能克服无量纲化对因素作用的大小,算法简便,结果合理可靠,能为系统发展变化态势提供量化的度量,适合因素间关联程度的衡量和动态趋势分析。采用结构变动度分析某时期内的费用结构变动情况,可以综合表达费用在年度和项目上的的构成变化,反映出住院医疗费用结构变化的总体特征。

长期住院对慢性精神分裂症患者认知功能的影响

目的测评慢性精神分裂症患者认知功能,探讨长期住院对慢性精神分裂症患者认知功能的影响。方法选取2016年1~12月上海市嘉定区精神卫生中心及徐汇区精神卫生中心符合疾病和有关健康问题的国际统计分类第十次修订本(ICD-10)中精神分裂症诊断标准的住院患者313例,其中,长期住院患者(长期住院组)188例,短期住院患者(短期住院组)125例。使用认知功能成套测验-共识版评估两组患者认知功能各维度因子得分,比较两组患者认知功能的差异,同时进行相关性分析。结果与短期住院组比较发现,长期住院组患者连线测验、霍普金斯词语学习测验修订版、空间广度、语义流畅性、符号编码、迷宫、两位数目及三位数目持续操作能力测验量表得分均较低,且连线测验量表分两组差异有统计学意义(t=2.328,P=0.021)。相关性分析显示,连线测验量表分与年龄、病程、住院次数、符号编码、迷宫、语义流畅性、空间广度、霍普金斯词语学习测验修订版、两位数、三位数及四位数持续操作能力测验得分具有相关性(P<0.01)。结论长期住院加重慢性精神分裂症患者认知功能的损害,年龄越大、病程越长、住院次数越多影响越大。