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.

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。

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。

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.

慢性住院精神分裂症男性患者的需求层次及在康复训练中的应用

目的了解慢性精神分裂症男性患者的需求层次,探索心理需求在康复训练中的应用。方法以慢性精神分裂症住院患者76例为研究对象,参照马斯洛需求层次理论,自行设计需求调查清单,了解患者在生理、安全、爱与归属、尊重及自我实现等各层次需求,并将调查结果应用于康复训练。结果慢性精神分裂症患者的生理需求和安全需求评分高于健康受试者(P<0.01),爱与归属及尊重评分2组差异无统计学意义(P>0.05),患者自我实现评分低于健康受试者(P<0.01)。患者各层次需求之间评分差异无统计学意义(F=0.57,P=0.68),PANSS总分与生理需求评分呈负相关(P<0.05),年龄与自我实现评分呈负相关(P<0.05)。训练12周后,研究组社会功能评分较入组时明显升高,并明显高于对照组,评分差异均有统计学意义(P<0.01)。研究组阴性症状评分较入组时下降,差异有统计学意义(P=0.035)。结论慢性精神分裂症患者需求层次与健康人群比较存在差异,将需求层次用于康复训练可使患者受益。

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 .

医院社区一体化管理模式对严重精神分裂症患者肇事肇祸行为、精神状态及社会功能的影响

目的探讨医院社区一体化管理模式对严重精神分裂症患者肇事肇祸行为、精神状态及社会功能的影响。方法选取2020年1月至2022年2月在福建省泉州市第三医院确诊的92例严重精神分裂症患者作为研究对象,根据患者入院时间进行分组,选取2020年1月至2021年1月确诊的45例患者为对照组,选取2021年2月至2022年2月确诊的47例患者为观察组。对于对照组按照常规方式进行管理,对于观察组实施医院社区一体化管理的方式进行管理,干预6个月。干预前后,分别观察两组肇事肇祸行为、精神状态及社会功能。结果两组干预前的社会功能缺陷筛选量表(SDSS)评分和阳性和阴性症状量表(PANSS)评分比较,差异无统计学意义(P>0.05);观察组和对照组干预6个月后的SDSS评分、PANSS评分均低于本组干预前,差异有统计学意义(P<0.05),观察组患者干预6个月后的SDSS评分和PANSS评分低于对照组,差异有统计学意义(P<0.05);两组干预前的肇事肇祸率比较,差异无统计学意义(P>0.05);观察组干预6个月后的肇事肇祸率低于本组干预前,差异有统计学意义(P<0.05),对照组干预6个月后的肇事肇祸率与本组干预前比较,差异无统计学意义(P>0.05);观察组患者干预6个月后的肇事肇祸率低于对照组,差异有统计学意义(P<0.05)。结论在严重精神分裂症患者接受治疗时给予医院社区一体化的管理模式,对于降低其肇事肇祸行为发生率、改善精神状态及社会功能有重要作用。

长期住院精神分裂症患者心电图QTc间期延长的影响因素分析

目的:探讨长期住院精神分裂症患者的心电图QTc间期延长检出率及影响因素。方法:纳入2020年6月在武汉市精神卫生中心住院的精神分裂症患者中符合要求长期住院的患者,收集临床资料,以QTc间期>440 ms为延长的标准,将患者分为QTc延长组和正常组,比较两组的基本特征和实验室指标,分析QTc间期延长的影响因素。结果:共纳入患者111例,22例患者QTc间期延长,QTc间期延长检出率19.82%;QTc间期延长组和正常组在性别、年龄、体质量指数(BMI)、空腹血糖(FPG)、血钾(K)方面差异具有统计学意义(P均<0.05);多因素Logistic回归分析发现性别、年龄、FPG、K为长期住院精神分裂症患者QTc间期延长的独立影响因素。结论:长期住院精神分裂症患者心电图QTc间期延长检出率较高,性别、年龄、FPG、K是其独立影响因素,临床上应予以重视,防止发生猝死。

生态系统理论下长期住院精神分裂症患者的生存困境及提升生存质量的路径探索

目的:探讨长期住院精神分裂症患者当前的康复环境和生活状况,探索其现状与需求,探索改善长期住院精神分裂症患者生存质量的路径。方法:对上海市某精神卫生中心的12名长期住院患者(住院时间>1年)进行半结构式访谈。结果:通过分析归纳,整合出5个主题:长期住院的患者对疾病具有更全面的认知;家属和患者对医院存在依赖;患者对人生的态度经历了渴望到绝望的转变;患者对履行民事权利存在事实性受限。结论:本研究提示对突破长期住院精神分裂症患者困境的路径:培养患者的自我管理能力,减轻病耻感,提升自信心,创造希望;完善患者的社会支持系统,拓展患者及家庭对疾病的应对方式;畅通政策渠道,保护患者的民事权利。

长期住院精神分裂症病人骨质疏松风险预测模型的构建及验证

目的建立长期住院精神分裂症病人骨质疏松风险预测模型,并进行验证。方法选择2018年1月至2021年10月在眉山市中医医院长期住院的精神分裂症病人436例进行回顾性分析。收集可能引起骨质疏松的相关因素,根据病人骨量情况分为两组,比较两组病人基本资料及生化指标,并以多因素logistic回归分析长期住院精神分裂症病人骨质疏松的影响因素,以此建立列线图模型并进行验证。结果多因素logistic回归分析结果显示:性别、年龄、服药年限、联合使用精神病药物、血钙、骨折史及血清泌乳素为长期住院精神分裂症病人骨质疏松的独立性影响因素(P<0.05)。以上述指标建立的列线图模型具有较高的区分度[ROC曲线下面积为0.70,95%CI:(0.65,0.75)]及预测准确度(平均绝对误差为0.02,预测曲线与标准曲线基本拟合)。结论长期住院精神分裂症病人骨质疏松主要受病人性别、年龄、服药年限等7个因素的影响,基于上述因素构建的列线图模型具有较高的区分度及预测准确度。

长期住院精神分裂症患者代谢综合征现状和相关影响因素

目的探究长期住院精神分裂症患者伴发代谢综合征的现状和相关影响因素。方法方便选取2022年6—9月于天津市安定医院精神八科长期住院的98例精神分裂症患者作为研究对象,根据患者是否合并代谢综合征,将患者分为病例组和对照组,其中病例组39例,对照组59例,比较患者的各项临床资料及相关影响因素。结果对照组年龄小于65岁、单一用药的患者占比高于病例组,差异有统计学意义(P<0.05)。Logistic回归分析显示,性别、年龄、用药情况均为长期住院精神分裂患者伴发代谢综合征的风险因素(OR=3.262、2.344、3.381,P<0.05)。结论女性、年龄越大以及联合用药者更易合并代谢综合征,为临床早识别早发现以及降低精神分裂症患者伴发代谢综合征提供依据。

长期住院的精神分裂症患者糖脂代谢变化轨迹:一项真实世界研究

目的描绘长期住院的精神分裂症患者糖脂代谢变化轨迹。方法纳入2014年–2022年在深圳市康宁医院住院、符合《国际疾病分类(第10版)》(ICD-10)精神分裂症诊断标准的患者为研究对象,对患者进行基于真实世界的纵向糖代谢(空腹血糖、糖化血红蛋白、C-肽)和脂代谢(甘油三酯、低密度脂蛋白、高密度脂蛋白、总胆固醇)随访数据的观察。访视频率为每年1次,共随访8年,总访视次数为9次。结果糖代谢指标方面,空腹血糖水平在第7次访视时降为4.87 mmol/L,低于基线水平(P<0.01);糖化血红蛋白在第9次访视时为6.08%,高于基线水平(P<0.05);C-肽水平在第7次访视为3.14 ng/mL,高于基线水平(P<0.01)。脂代谢指标方面,从第2次访视开始,高密度脂蛋白水平均低于基线水平(P均<0.01),其后基本稳定;总胆固醇水平在最后3次访视时分别为4.06、4.07、3.95 mmol/L,均低于基线水平(P均<0.01)。结论长期住院的精神分裂症患者糖脂代谢指标在8年随访期间的变化总体较平稳。

风险预测模型下住院精神分裂症患者暴力行为的危险因素分析

目的 探究基于风险预测模型管理模式在住院精神分裂症患者中的应用。方法 回顾性分析2020年8月至2022年8月在温州市第七人民医院住院治疗的500例精神分裂症患者的临床资料,选取334例患者,根据出院后外显攻击行为量表(modified overt aggression scales, MOAS)评分分为105例暴力行为组和229例非暴力行为组。分析影响因素并进行多因素回归分析,建立风险预测模型并对其中有暴力行为的166例患者进行验证,分析其临床预测价值。结果 暴力行为组患者的年龄、家庭经济状况、抚养方式、治疗状况、智力、住院方式、职业、既往暴力行为、妄想、精神症状和易激怒比例明显差于非暴力行为组,差异有统计学意义(P<0.05);经Cox多因素分析,治疗状况、智力、住院方式、既往暴力行为、妄想、精神症状和易激怒为精神分裂症患者发生暴力行为的独立危险因素(P<0.05);风险预测模型预测住院精神分裂症患者暴力行为发生的受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)下面积为0.941(95%CI:0.051~0.142,P<0.05);预测暴力行为发生的临界值阳性率≥93.98%时,其特异性为0.915、敏感度为0.964。结论 以治疗状况、智力、住院方式、既往暴力行为、妄想、精神症状和易激怒为危险因素建立风险预测模型可有效预测住院精神分裂症患者暴力行为的发生,且具有较高的特异性和敏感度,对临床干预具有重要的指导意义。