| OBJECTIVE To carry out a five-year follow-up with child patients with schizophrenia by standardized assessment tool at 3 month, 1 year,2 year,.3 year,4 year,5 year respectively.We observe clinic outcome and social function outcome of child patients and explore the related predictors,so that can scientific advices be provided for diagnosis,treatment and prevention of those patients.METHODS 81 childhood-onset first-episode schizophrenics were recruited who were admitted to Shandong mental health center from June 1,2008 to May 31.2010.With Self-made General Condition Survey List,Modified Promorbid Adjustment Scale,Positive and Negative Syndrome Scale, The Questionnaire of Adverse Childhood Experiences,Personal and Social Performance Scale and Wechsler Intelligence Scale for Children,data information was collected at baseline with demographics, premorbid social adjustmen level,clinic characters and psychopathology.We collected all indices such as admission times,medication compliance,species, medication conversion,early positive symptom remission and PANSS score at each interview during 5-year follow-up.At the end of it,data was gathered in relieving months of positive symptom and negative symptom, PSP score.It was analysed with T test ,X2 test, multivariable linear regression model and logisitc regression model.RESULTS 1.The boys ranged from 7 to 14 at onset while girls from 6.5 to 12.There was gender difference in age of onset by Kaplan-Meier survival analysis and girls had a ealier onset age than boys(log rank=4.99, P<0.05).The patients with positive family history accounted for 50.0% and those with inferior promorbid social adjustment55.9%.The patients with insidious onset account for 61.8%, and those with premorbid emotion and conduct problems wich need doctor-seeing 22.2%.Mean time of DUP was 8.33 months and proportion of the patients with high ACEs score was 47.1%.2.1n 81 patients,8 dropped out and 5 couldn’t meet the criteria of schizophrenia any more ,thus follow-up was completed in 68 cases.Diagnostic stability was 93.2%.During the follow-up time,admission times varied froml to 5 among them,and 48.5% of those patients kept good medication adherence. At the end of follow-up, only 3(4.4%)patients was not taking medicine and 40(61.5%)patients was taking two kinds of antipsychotics.Mood stabilizer,antidepressants and benzodiazepines were taken in 12 cases,16 cases and 5 cases among the patients,accounting for 17.6%, 23.5%, 5.9%respectively. 34(50%) patients have changed treatment regimen more than two times and only 10(14.7%) were being applied with original therapy.3.At the end of follow-up period, positive factor score ,anxiety-depression factor score and hostility factor of PANSS decreased significantly from baseline in children schizophrenics while negnitive factor score increased significantly,There was no significant difference between baseline and end point in cognitive factor.Clicnic outcome of patients was assessed with early-remission of positive symptom and remisson time of positive and negnitive symptom.Results showed that the number of patients who acquired early positive symptom remission was 27 and the early remission rate was 34.6%.The continuous months of positive and negative symptom remission are 18.78±7,19(6-38) and 17.51 ±3.75(7-24) months respectively.Social function outcome of the patients was evaluated with PSP score. Mean score of PSP was 40.06.14 patients scored less than 30 and 54 patients between 30 and 70 ,accounting for 20.6% and 79.4% respectively.4.1t showed that type of onset was a preditor of early positive remission by linear regression and logistic regressiom analysis.PAS score,medicaton compliance and WICS score at baseline were predictors for positive remission time,accounting for 44.4% of overall variance.DUP and negative factor score at baseline predicted negative remission time,accounting for 54.5% of overall variance while DUP,PAS score,early positive symptom remission and negative symptom remission time predicted PSP score which accounted for 39.7%. The effect of PAS scor on PSP score was partially mediated by positive symptom remission time,which made up 24.1% of all effect,however,the effect of DUP on it was completely mediated by negative symptom remisson time through mediating analysis.CONCLUSIONS:1.The onset-age in girls was earlier than in boys in this study .The majority of children with schizophrenia had positive family history and insidious onset, accounting for 50.0% and 61.8%, the proportion of patients with premorbid poor social adaptation and th adverse life events were relatively high,accounting for 55.9%, 47.1% respevtively.2.Among these patients there were high diagnosis reliability and relatively good mediation compliance,but the patients who were taking two antipsychotics and have altered medication regimen were not a few.3.At the end of follow-up,positive, anxiety-depression and hostility symptoms improved significantly from baseline in childhood onset schizophenics,while negative symptoms deteriorated dramatically. Cognitive symptoms was similar to those at baseline. All the patients have severe or moderate impairment of social function.implicating a unfavorable prognosis.4.The factors impacting on prognosis were complicated.Patients with acute and subcute onset were prone to acquire early remission in positive symptom.Poor premorbid social adjustment level,unfavorable medication compliance,and severe cognitive impairment were risk factors of obtaining a relative short period of positive symptom remission while long DUP and severe negative symptom at baseline were risk factors of a relative short period of negative remission.poor premorbid social function ,lack of early positive remission and short negative symptom remission time were risk factors of poor social function outcome.Poor premorbid social adjustment could make a direct imfact on social function outcome as well as make indirect imfact on it through remission time of positive symptom.DUP indirectly affected social function through remission time of negnitive symptom.We should attach great importance to the risk factors and take effective measures to shorten DUP and improve the compliance of schizophrenic patients for taking medicine,so that could the purpose of diminishing social function impairment and improving prognosis be realized. |
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