Analysis Of Clinical Effects And Correlation Factors On Integrated Treatment Of Stable Schizophrenia

Objective:To explore the influencing factors on cognitive function and other clinical characters of stable schizophrenia.Compare the effect of integrated treatment group and control group.The study is aimed to provide corresponding basis for integrated treatment modle which can improve the stable schizophrenia patient's outcome used in our country.Methods:1.137 outpatients in Shanghai Mental Health Central from July in 2005 to March in 2006,all the patients are cured by only one kind of Second Generation Antipsychotics.There are 29 patients in Risperidone group,44 patients in Zyprexa group,36 patients in Seroquel group,28 patients in Brisking group.2.Every antipsychotics group was randomly divided into control group and integrated treatment group,integrated treatment was additionally combined with bio-psycho-social intervention which included healthy education,social skills training, vocational rehabilitation and psychotherapy.There were 70 patients in control group and 67 patients in integrated treatment group.Integrated treatment group was divided into 4 groups,every group which fixed had 16 or 17 patients,healthy education, social skills training and psychotherapy were carried out one times every month,and vocational rehabilitation was carried out one times every 3 months.All subjects were evaluated using Positive and Negative Syndrome Scale(PANSS),Montgomery and Asberg Depression Rating Scale(MADRS),Treatment Emergent Symptom Scale (TESS),Family Burden Scale(FBS)every 3 months,and Short-Form-36 Health Survey(SF-36),Social Disability Screening Schedule(SDSS),Activity of Daily Living scale(ADL),Life Events Scale(LES)every 6 months.Cognitive function which included Wisconsion Card Sorting Test(WCST),Continuous Performance Test(CPT), Trail Making Test(TMTA and TMTB),Digit Symbol and Digit Span in Wechsler Adult Intelligence Scale Revised in China(WAIS-RC),Visual Reproduction in Wechsler Memory Scale-Revised in China(WMS-RC)was evaluated every 6 months.3.Statistical approaches such as t test,anova analysis,Pearson's x~2 statistics,Stepwise multiple regression analyses,Logistic regression analysis,Pearson correlation analysis were employed to analyze the data according to the characteristic of the distribution of data. The statistical software used throughout the analysis was SPSS13.Results:1.Cognitive function of stable schizophrenia patients were influenced by age,gender,education level,antipsychotics and psychosis symptom.The patients' psychosis symptom showed significantly correlation with SDSS,ADL and FBS. Married patients' negative and depression symptom's score was significantly higher than un-married patients.2.After 6 months,integrated treatment group's score of PANSS general pathology scale(P＜0.01),PANSS total score(P＜0.05),SDSS (P＜0.05)and ADL'S(P＜0.05)score were significantly lower than control group. Integrated treatment group spent less time to finish the TMTB test than control group (P＜0.01).The score of relative's mental health in FBS is significantly lower than control group(P＜0.05).The improvement of quality life in integrated treatment group was better than control group.3.In integrated treatment group,college group's depression symptom and family daily activity in FBS'S score were lower than high school and below group(P＜0.05).The improvement of negative symptom in Aripiprazole group is better than other groups.4.The higher of PANSS,FBS and LES negative life event's score,the lower of the quality life.The higher of PANSS general pathology and ADL score reduction rate,the better improvement of the quality life.5.The side effect of too much sleep is more frequency on quetiapine(x~2 =8.687 P＜0.05),extrapyramidal side effect is more frequency on risperidone(x~2 =7.809 P＜0.05),weight gain is more frequency on olanzapine(x~2 =12.370 P＜0.01).Conclusion:1.Cognitive function of stable schizophrenia was influenced by many factors.2.Marriage could protect stable schizophrenia patients' psychosis symptom. 3.Psychosis symptom is the reason of stable schizophrenia patients' lower social function and quality life and higher family burden.4.Integrated treatment would improve stable schizophrenia patients' cognitive function,psychosis symptom,social function,family burden and quality of life better than control group.The effect of integrated treatment for higher education patients is better.Aripiprazole could improve negative symptom in integrated group.5.The side effect of four kinds of second generation antipsychotic is different,so it should be choose by the patients' tolerance.6.Continue this study for a longer time would judge the Integrated treatment more credibly,and explore the stable schizophrenia patients' long term outcome.