| Objective The risk of disruptive behaviors of community-dwelling patients with schizophrenia is one of the most important factors affecting their rehabilitation and return to society.This research project focuses on early recognition of the risk factors for patients’ disruptive behaviors and on patients’ recovery and return to society.Methods From January 2018 to May 2019 all individuals with a diagnosis of schizophrenia registered in 8 counties that are representative samples of Ningxia counties(including Xingqing District,Pengyang,etc.)were included as potential subjects.A telephone survey specifically developed for the study was administered to patients’ family members by investigators who received standardized training.If it was not possible to make telephone contact,the questionnaire was administered in a home visit.As part of the survey,the risk of disruptive behaviors was assessed based on <the Risk Assessment Form of Causing Accidents in the National Standards for the Management and Service of Patients with Severe Mental Disorders>,which assesses the risk of disruptive behaviors on a 0 to 5 scale.Ordinal logistic regression analyzes were employed to identify factors associated with the risk of disruptive behavior both over the total course of the disease and over the prior year.A binary logistic regression model was used to identify factors associated with aggressive behaviors and self-harm behaviors over the prior year in these individuals with schizophrenia.Results 1.The analysis included 1,795 individuals with schizophrenia:the male-to-female ratio was 1:1.25;the average age was 47.9±12.7 years;the average years of formal education was 6.2±4.7 years;74.4% were of the Han ethnicity;and 75.3% live in rural communities.2.Among the patients,848(47.2%)had a high risk of disruptive behaviors(that is,score of 3or greater on the 0 to 5 scale)at some point during the course of their illness.Ordinal logistic regression analysis indicated that after adjusting for all variables in the model the prior risk of disruptive behavior was higher in male patients(OR=1.58,95%CI:1.33-1.88),in individuals living in rural communities(OR=1.30,95%CI:1.03-1.65),in patients who reported more types of prior positive psychotic symptoms(OR = 1.72,95% CI: 1.58-1.87),and in patients who were currently receiving more types of social welfare benefits(OR = 1.19,95% CI: 1.07-1.33).On the other hand,the risk of prior disruptive behaviors was lower in patients with higher levels of education(OR = 0.96,95% CI: 0.94-0.98)and in patients with a later age of onset(OR = 0.98,95% CI: 0.97-0.99).3.Among these patients with schizophrenia,329(18.3)had a high risk of disruptive behavior(that is,score of 3 or greater)over the prior year.Ordinal logistic regression indicated that compared to patients who regularly took antipsychotic medication over the last year,the risk of disruptive behavior was greater among those who had not taken antipsychotic medications in the prior year(OR=1.38,95%CI:1.07-1.79)and greater in those who had intermittently taken medication in the prior year(OR=1.79,95%CI:1.37-2.35).Greater risk of disruptive behavior in the prior year was also associated with younger current age(OR=0.97,95%CI:0.96-0.98),lower levels of education(OR=0.96,95%CI:0.94-0.98),greater number of prior positive psychotic symptoms(OR=1.46,95%CI:1.33-1.60),and current receipt of more types of social welfare benefits(OR=1.27,95%CI:1.13-1.43).4.Among these patients with schizophrenia,217(12.1%)reported physically harming others in the prior year.Logistic regression analysis identified several factors associated with risk of harming others in the last year: rural residence(OR=1.57,95%CI:1.08-2.27);receiving poverty relief benefits(OR=1.44,95%CI:1.06-1.94);reporting more types of prior positive psychotic symptoms(OR=1.35,95%CI:1.16-1.56);and a lower age of onset of illness(OR=0.96,95%CI:0.95-0.97).5.Among these patients,93(5.2%)reported taken self-injured behavior in the last year.Logistic regression revealed self-injury was associated with the reported number of types of past psychotic symptoms(OR=1.57,95%CI:1.24-1.98).Conclusion 1.The proportion of community-dwelling individuals with schizophrenia who reported disruptive behaviors was lower in this region than elsewhere,and there were slight differences in the proportions reported in the different counties assessed.The patients’ age,location of residence,years of formal education,age of first onset,number of types of previous positive psychotic symptoms reported,and usage of antipsychotic medications in the prior year were all associated with the risk of disruptive behaviors.2.For patients with schizophrenia who report previously experiencing multiple types of positive psychotic symptoms and are currently non-compliant with antipsychotic medication,reducing the risk of disruptive and violent behaviors requires taking an "early detection and early treatment" approach to the management of their illness.For young patients living in rural communities who have low levels of education and an early onset of illness,reducing disruptive and violent behaviors will depend on family caregivers and community workers who should focus their efforts on "early prevention and detailed daily management". |
