Community-dwelling Schizophrenia Patients Research Articles

Association between cognitive insight and anxiety among community-dwelling schizophrenia patients: the chain mediating effects of family cohesion and chronotype.

To investigate the effect of cognitive insight on anxiety in community-dwelling schizophrenia patients and to construct a chain mediating model to determine the underlying mechanisms of the relationship between cognitive insight and anxiety through family cohesion and chronotype. The Beck Cognitive Insight Scale, the Chinese version of the Family Adaptability and Cohesion Scale, the Morningness-Eveningness Scale, and the Generalized Anxiety Disorder Scale were used to assess cognitive insight, family cohesion, chronotype, and anxiety in a sample of 785 individuals with schizophrenia living in the community. Spearman correlation analysis, multiple linear regression and Bootstrap methods were employed to analyze the four variables. Residential region, current employment status, and family economic status impacted anxiety among community-dwelling schizophrenia patients. All variables were associated with each other, but self-certainty was not significantly associated with anxiety. Cognitive insight and self-reflection had direct effects on anxiety, as well as indirect effects on anxiety through the partial mediating effect of chronotype, the suppressing effect of family cohesion, and the chain mediating effect of family cohesion and chronotype. Family cohesion and chronotype can mediate the relationship between cognitive insight and anxiety. Improving family functioning, promoting emotional relationships within families, and correcting non-circadian sleep patterns can reduce anxiety in community-dwelling schizophrenia patients, with important implications for improving adverse mental health outcomes.

The association between symptomatic remission and social support in community-dwelling schizophrenia patients during COVID-19.

Schizophrenia is a severe and enduring psychiatric disorder, characterized by substantial challenges in achieving symptomatic remission. Up to now, there have been limited studies examining the association between remission status and social support in patients with schizophrenia during COVID-19. This study aimed to investigate the remission status of community-dwelling schizophrenia patients during the pandemic and explore whether symptomatic remission is significantly associated with social support in a cross-sectional study. 727 schizophrenia patients were recruited using a cluster random sampling method in the local community. Face-to-face interviews were used to gather data on participants' clinical characteristics, sociodemographic, social support, and symptomatic remission criteria. Logistic regression models were deployed to identify potential relationships between symptomatic remission and social support. Among the 727 patients in our study, a substantial proportion of 522 (71.80%) achieved symptomatic remission, while 205 (28.2%) did not. Remarkably, those who achieved symptomatic remission exhibited a higher level of social support (28.32 ± 6.82) compared to those who did not. The proportion of patients achieving symptomatic remission in the low (19.4%), medium (46.2%), and high (34.3%) social support groups was 56.7%, 66.1%, and 88.0%, respectively. Moreover, the crude odds ratio for the association between social support and symptomatic remission was 3.20 (95% CI: 2.45-4.18). After controlling for all confounding factors, the adjusted odds ratio remained significant at 3.02 (95% CI: 2.30-3.97). This consistent association underscores the critical role of social support in influencing symptomatic remission among community-dwelling schizophrenia patients, especially during the COVID-19 pandemic. Reinforcing the utilization of social support for fostering symptomatic remission among individuals with schizophrenia who reside in the community during such crises is recommended.

The relationship between sleep disturbance and aggressive behaviour among community-dwelling schizophrenia patients: a moderated mesomeric effect model

ObjectiveSleep disturbance is the most common concern of patients with schizophrenia and can lead to a poor prognosis, a low survival rate and aggressive behaviour, posing a significant threat to social security and stability. The aim of this study was to explore the mediating role of depression in the relationship between sleep disturbance and aggressive behaviour in people with schizophrenia living in the community, as well as the regulatory role of family intimacy and adaptability. These findings, in turn, may provide a theoretical basis and constructive suggestions for addressing the physical and mental health problems of these patients.MethodFrom September 2020 to August 2021, a convenience sampling method was used to select schizophrenia patients from the community attending follow-up appointments at the Fourth People’s Hospital of Pengzhou City, China. The researchers conducted a survey in the form of a star questionnaire. The survey included questions about general demographic data and disease-related questionnaires: the Pittsburgh Sleep Quality Index (PSQI), the revised Chinese version of the Modified Over Aggression Scale (MOAS), the Self-Rating Depression Scale (SDS), and the Family Adaptability and Cohesion Scale, Second Edition. FACES-II and SPSS 21.0 were used to organize and analyse the data.ResultsA total of 818 schizophrenia patients living in the community participated in the survey, and 785 valid questionnaires were ultimately collected, for a response rate of 95.97%. The results of multivariate analysis indicated that sex, number of psychiatric medications used, outpatient follow-up, history of hospitalization for mental disorders and sleep disturbances were factors influencing aggressive behaviour. Depression played a partial mediating role between sleep disturbance and aggressive behaviour, and the indirect effect size was 0.043 (57.33% of the total). In addition to sleep disturbance, family intimacy (β=-0.009, P < 0.01) and adaptability (β=-0.145, P < 0.001) can significantly predict depression.ConclusionThe findings indicate that sleep disturbance in schizophrenia patients in the community is a risk factor for aggressive behaviour, and depression plays a partial mediating role in the relationship among sleep disturbance, aggressive behaviour and family intimacy. In addition, adaptability plays a regulatory role in the relationship between depression and sleep disturbance.

Association between social support and the severity of positive symptoms in rural community-dwelling patients with schizophrenia during the COVID-19 pandemic

BackgroundThis study examined the association between social support and the severity of positive symptoms in rural community-dwelling schizophrenia patients during the COVID-19 pandemic.MethodThe cross-sectional study included 665 rural community-dwelling schizophrenia patients investigated during the COVID-19 pandemic. Social support was measured using the Social Support Rating Scale, and positive symptoms were assessed using the Positive Scale extracted from the Positive and Negative Syndrome Scale. Multiple linear regression was adopted to examine the association of social support with positive symptoms.ResultThe scores for total social support, subjective support, objective support and the use of social support were 28.3 ± 5.9, 16.4 ± 5.2, 6.5 ± 1.4 and 5.4 ± 2.8, respectively. Total social support (β = −0.08, 95%CI: −0.13 to −0.02, P < 0.01) and subjective social support (β = −0.10, 95%CI: −0.16 to −0.04, P < 0.01) were significantly and negatively associated with the Positive Scale score after adjustment for confounders. Objective social support (β = 0.11, 95%CI: −0.10 to 0.32, P = 0.31) and the use of social support (β = −0.03, 95%CI: −0.14 to 0.07, P = 0.53) were not significantly associated with the Positive Scale score.ConclusionThe study confirmed the importance of social support, especially subjective support, provided to rural community-dwelling schizophrenia patients during the COVID-19 pandemic. This support should be addressed and strengthened for such patients in emergent events.

A randomized, prospective, active-controlled study comparing intramuscular long-acting paliperidone palmitate versus oral antipsychotics in patients with schizophrenia at risk of violent behavior

ObjectivePaliperidone palmitate (PP) is an effective long-acting antipsychotic injection, but its impact on the behavior of schizophrenia patients with dangerous tendencies requires further investigation. This study aims to explore the effects of long-term antipsychotic treatment on this population in the community. MethodsThis 49-week, randomized controlled trial was conducted across 21 communities in Wuhan and enrolled 134 schizophrenia patients at risk for violent behavior. With a fixed block size of 10, participants were randomly assigned to receive either intramuscular PP 1-month formulation (PP1M) or oral antipsychotic medication (OAP) at a 1:1 ratio. Changes in patients' risk for violent/aggressive behavior, family burden, social, and cognitive functioning were measured using VRAPP, MOAS, PANSS, FBS, PSP, and RBANS scales from baseline to endpoint. Longitudinal data from multiple repeated measures were analyzed using linear mixed-effects models. ResultsThe study protocol was completed by 77.6% of the patients overall. Significant improvements were observed in the risk assessment scores, MOAS total score, PANSS total score, PSP total score, and FBS total score of patients in the PP1M group from baseline to the end of treatment (all P < 0.05). Importantly, compared to patients in the OAP group, the improvements in these measures were also significantly greater in the PP1M group. Commonly observed AEs, such as hyperprolactinemia (70.3% vs. 62.65%) and muscle tension (45.3% vs. 57.8%), were considered to be the PP-related AEs. Nonetheless, the differences between the two groups did not reach statistical significance, and no new safety concerns emerged. ConclusionsOur study suggests that PP long-acting injection (LAI) is a safe and effective treatment option for community-dwelling schizophrenia patients with impulsive violence and risky behaviors.

Medication adherence among community-dwelling schizophrenia patients during the COVID-19 pandemic: A cross-sectional study

ObjectivesThis study aims to investigate medication adherence during the COVID-19 pandemic among community-dwelling schizophrenia patients, and to explore the role of social support in improving medication adherence in a rural community sample in China. MethodsA cross-sectional sample of 800 patients was recruited using a cluster random sampling method in Yingshan County, Sichuan Province. Information on participant demographic characteristics, social support and medication adherence was collected through face-to-face interviews. The data analysis was performed using SAS9.4. Two binary logistic regression models were employed to identify the association between regular medication use and social support. ResultsThe rate of regular medication adherence among community-dwelling patients with schizophrenia was 41.5%,which was lower than that indicated by recent research(Li et al., 2020) before COVID-19 in western rural China. The mean scores and standard deviation of the patient's objective support, subjective support, and support utilization were 4.94 ± 1.57, 17.03 ± 5.24, and 5.25 ± 2.75, respectively. The social support standard deviation was 27.22 ± 6.32. The crude odds ratio of objective support, subjective support, and support utilization were 0.790 (95%CI:0.713–0.876), 0.999 (95%CI:0.971–1.027), and 1.049 (95%CI:0.995–1.105) respectively. After adjusting for potential factors, the adjusted odds ratio of objective support, subjective support, and support utilization were 0.758 (95%CI:0.673–0.853), 1.030 (95%CI:0.994–1.068), and 1.043 (95%CI:0.985–1.105), respectively. ConclusionsDuring the COVID-19 pandemic, community-dwelling schizophrenia patients had a low rate of regular medication adherence. This was particularly true of those who were older adults, less educated and living in rural areas. The results of this study suggest that strengthening social support may effectively improve medication adherence for those patients.

Improving Medication Adherence in Community-Dwelling Patients with Schizophrenia Through Therapeutic Alliance and Medication Attitude: A Serial Multiple Mediation Model.

BackgroundIncreased medication adherence improves patient outcomes and lowers the overall cost of care by preventing disease relapse and hospital readmission. Several systematic reviews have identified that insight, therapeutic alliance, and attitude towards medication affect medication adherence in patients with schizophrenia; however, no study has examined all the aforementioned variables together nor has discussed the chains of these mediators.PurposeTo examine the insight–medication adherence relationship among community-dwelling schizophrenia patients through a serial multiple mediation model of therapeutic alliance and medication attitude.Patients and MethodsThis study with a cross-sectional correlational design included a convenience sample of community-dwelling schizophrenia patients from Taiwan (n = 229). From January 2017 to January 2018, data were collected by trained nurses using questionnaires. The PROCESS tool was used to analyse fine-grained chains.ResultsIn serial multiple mediation, the indirect effect of insight on medication adherence through therapeutic alliance and, subsequently, alteration of medication attitude was significant. However, the direct effect changed from significant to non-significant, indicating a complete mediating effect.ConclusionIn community-dwelling schizophrenia patients, the effects of therapeutic alliance and medication attitude on medication adherence are greater than that of insight. We recommend revising the strategy of community home visits by different psychiatrists or nurses in alternating shifts. Therapeutic alliance is the first step required to promote medication adherence. Based on this alliance, altering the patients’ medication attitude may be more effective in improving medication adherence than merely enhancing insight.

The Association of Social Support and Symptomatic Remission among Community-Dwelling Schizophrenia Patients: A Cross-Sectional Study.

Schizophrenia is a mental disease that often leads to chronicity. Social support could reduce the severity of psychotic symptoms; therefore, its influence on remission should be examined. This study investigated the remission rates in community-dwelling schizophrenia patients and examined the association between social support and remission status. A cross-sectional study was conducted in 129 schizophrenia patients in Taiwan. Remission rates were evaluated, and the level of social support, clinical characteristics, sociodemographic variables, and healthy lifestyle status were compared between the remission and nonremission groups. The association between social support and remission was analyzed after adjusting for confounding factors. The mean illness duration is 12.9 years. More than 95% of the participants lived with their families, 63% were unemployed, and 43% achieved remission. Higher social support was observed in the remission group, and a significant correlation was observed between family domain of social support and remission status. Family support was a protective factor of symptomatic remission in community-dwelling schizophrenia patients in Taiwan. The results reflect the effects of a family-centered culture on patients during illness. Consequently, reinforcing family relationships and the capacity of families to manage the symptoms of patients and providing support to families are recommended.

Accuracy of self-assessment of real-life functioning in schizophrenia

A consensus has not yet been reached regarding the accuracy of people with schizophrenia in self-reporting their real-life functioning. In a large (n = 618) cohort of stable, community-dwelling schizophrenia patients we sought to: (1) examine the concordance of patients’ reports of their real-life functioning with the reports of their key caregiver; (2) identify which patient characteristics are associated to the differences between patients and informants. Patient-caregiver concordance of the ratings in three Specific Level of Functioning Scale (SLOF) domains (interpersonal relationships, everyday life skills, work skills) was evaluated with matched-pair t tests, the Lin’s concordance correlation, Somers’ D, and Bland–Altman plots with limits of agreement (LOA). Predictors of the patient-caregiver differences in SLOF ratings were assessed with a linear regression with multivariable fractional polynomials. Patients’ self-evaluation of functioning was higher than caregivers’ in all the evaluated domains of the SLOF and 17.6% of the patients exceeded the LOA, thus providing a self-evaluation discordant from their key caregivers. The strongest predictors of patient-caregiver discrepancies were caregivers’ ratings in each SLOF domain. In clinically stable outpatients with a moderate degree of functional impairment, self-evaluation with the SLOF scale can become a useful, informative and reliable clinical tool to design a tailored rehabilitation program.

Impact of long-term institutionalization on experiential pleasure and motivation in patients with schizophrenia.

Anhedonia and amotivation, the hallmarks of negative symptoms in schizophrenia, are believed to be due to "emotion-behavior decoupling," a failure in translating pleasure experience into appropriate goal-directed behavior. A number of studies have reported that long-term institutionalized schizophrenia patients suffer from more severe negative symptoms than community-dwelling patients, but few studies have investigated pleasure experience and motivational behavior in schizophrenia patients who have experienced long-term institutionalization. In this study, we recruited 26 long-term institutionalized schizophrenia patients, 27 community-dwelling schizophrenia patients, and 27 healthy controls. Participants were administered two specific computer-based tasks to assess anhedonia and amotivation. The Anticipatory and Consummatory Pleasure (ACP) Task was used to measure emotion-behavior decoupling and the Effort-Expenditure for Rewards Task (EEfRT) was used to measure amotivation related to rewards. Findings from the ACP Task showed that compared with healthy controls, the coupling between emotion experience and motivated behavior was significantly weaker in both clinical groups, suggesting that emotion-behavior decoupling could be a stable trait in schizophrenia patients. In the EEfRT, compared with both community-dwelling patients and healthy controls, institutionalized patients with schizophrenia failed to expend more effort to gain potential rewards even when reward probability increased. These findings further reveal the underlying mechanism of anhedonia and amotivation and their potential relationships with long-term institutionalization in patients with schizophrenia.

Predictors of residency status in chronically institutionalized and community dwelling schizophrenia patients

BackgroundThis cross-sectional study contrasted chronically hospitalized schizophrenia (SZ) spectrum disorder inpatients to SZ community dwelling patients on measures of psychopathology, social competence, neuropsychological performance and real-world functioning in order to discern factors predictive of patients' residency status and to characterize the contrasting ends of the SZ outcome continuum. MethodSubjects included 26 chronic SZ patients hospitalized continuously on average for 12.8 years, and 26 SZ patients with a history of at least 18 months tenure in community placement. ResultsA series of multivariate analyses revealed both chronically hospitalized and community dwelling patients were similar in terms of their real world functioning abilities such as work skills, interpersonal skills, self-care skills and community engagement. Chronic SZ inpatients' manifested more severe functional competency and neurocognitive deficits relative to outpatients. Additionally, chronic inpatients were discriminated from community dwelling outpatients by their symptom severity and commitment of more socially undesirable/antisocial type behaviors. ConclusionsFactors associated with chronic institutionalization are, in part, related to commission of antisocial type behaviors, as well as poor social and neurocognitive competences, and total symptom severity rather than deficits in everyday functional abilities.

Risk factors for increased duration of untreated psychosis. Results from the FACE-SZ dataset

ObjectivesReducing the duration of untreated psychosis (DUP) may improve the prognosis of schizophrenia. This study investigated the prevalence, and associated risk factors, of long DUP in a large, non-selected sample of community-dwelling schizophrenia patients (SZ). Method478 community-dwelling stable SZ participants (122 women and 356 men; mean age 32.37±9.86years) were recruited between 2010 and 2016. The mean retrospective DUP was evaluated from both patient and family reports, as well as hospital/psychiatrists records. Long DUP was defined as >2years. ResultsThe mean DUP was 1.5years. 80 participants (16.7%) had a DUP>2years. In multivariate analyses, after adjustment for sex, education level, history of childhood trauma and history of maternal schizophrenia or bipolar disorder, long DUP was associated with a younger age of illness onset (19.3±6.67years vs. 22.0±6.51years, adjusted odd ratio aOR=0.91, 95%CI [0.86; 0.97], p=0.003) and cannabis use disorder (20.0% vs. 10.3%, aOR=2.41, 95%CI [1.14–5.09], p=0.02). ConclusionA high proportion of SZ patients still have a long DUP. The present results suggest that illness onset before age 19years and cannabis use are associated with long DUP in schizophrenia patients. Early psychosis detection programs should prioritize the targeting of these populations.

Birth by cesarean section and schizophrenia. Results from the multi-center FACE-SZ dataset

ObjectivesChildren born by cesarean section (“c-birth”) are known to have different microbiota and a natural history of different disorders including allergy, asthma and overweight compared to vaginally born (“v-birth”) children. C-birth is not known to increase the risk of schizophrenia (SZ), but to be associated with an earlier age at onset. To further explore possible links between c-birth and SZ, we compared clinical and biological characteristics of c-born SZ patients compared to v-born ones.MethodFour hundred and fifty-four stable community-dwelling SZ patients (mean age = 32.4 years, 75.8% male gender) were systematically included in the multicentre network of FondaMental Expert Center for schizophrenia (FACE-SZ).ResultsOverall, 49 patients (10.8%) were c-born. These patients had a mean age at schizophrenia onset of 21.9 ± 6.7 years, a mean duration of illness of 10.5 ± 8.7 years and a mean PANSS total score of 70.9 ± 18.7. None of these variables was significantly associated with c-birth. Multivariate analysis showed that c-birth remained associated with lower peripheral inflammation (aOR = 0.07; 95% CI 0.009–0.555, P = 0.012) and lower premorbid ability (aOR = 0.945; 95% CI 0.898–0.994, P = 0.03) independently of age, age at illness onset, sex, education level, psychotic and mood symptomatology, antipsychotic treatment, tobacco consumption, birth weight and mothers suffering from schizophrenia or bipolar disorder.ConclusionAltogether, literature data as well as our results suggest that c-birth is associated with lower weight gain and lower inflammation in schizophrenia, which could be explained by microbiota differences. Further studies should take into account c-birth when exploring the role of microbiota in SZ patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Efficacy of Case Management for the Community Dwelling Schizophrenia Patients : A 36-Month Prospective Follow-Up Study

Jee Hoon Sohn, MD, PhD, Seung-Hee Ahn, MSW , Su Jeong Sung, MD, Ji Min Ryu, MD, Ji Eun Park, MD, and Maeng Je Cho, MD, PhD Department of Public Health and Medical Service, Seoul National University Hospital, Seoul, Korea Department of Psychiatry, Seoul National University Hospital, Seoul, Korea Jongno Community Mental Health Center, Seoul, Korea Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Korea 5 Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Korea

Limited practice effects and evaluation of expectation for change: MATRICS Consensus Cognitive Battery

Understanding of the impact of antipsychotic medications on cognition requires differentiating between treatment effects and practice effects. This prospective study examines expectations for change on neuropsychological assessments and possible differential practice effects in community dwelling schizophrenia patients (n=27) who are clinically stable and on a stable medication regimen when compared to demographically similar psychiatrically healthy controls (n=29). All participants were administered the MATRICS Consensus Cognitive Battery (MCCB) twice over a period of four weeks. The use of Regression Based Norms for Change (RBNC) and Reliable Change Index (RCI) was completed to anchor estimates of meaningful change to a demographically similar control group. A repeated measures ANOVA was used to examine the effects of time and diagnosis on MCCB composite scores. A repeated measures MANOVA was used to examine the effects of time and diagnosis, and their interaction for MCCB subtests. Estimates of meaningful change are provided. A significant main effect was observed for time; no significant interactions were observed. There was no support for differential practice effects. In the absence of any behavioral, cognitive, or pharmaceutical interventions, these findings suggest limited change in performance over time in either group.

Estimating the direct and indirect costs for community-dwelling patients with schizophrenia

Aim To estimate the schizophrenia-related direct and indirect costs for community-dwelling Americans sampled in the Medical Expenditure Panel Survey (MEPS) from the societal perspective. Methods Patients diagnosed with a schizophrenic disorder (International Classification of Disease 9th Revision (ICD-9) code 295) or other non-organic psychoses (ICD-9 code 298) between 1 January 2005 and 31 December 2008 were identified from the MEPS database. The following categories were included in calculating the schizophrenia-related direct medical costs: inpatient hospitalizations, prescription medications and hospital outpatient, emergency department, physician office, and home healthcare visits. The indirect costs were calculated using the human capital approach and included lost productivity due to missed work, reduced employment, premature death and caregivers’ costs. To account for the complex multistage sampling design of the MEPS, all statistical analyses were conducted using the survey procedure of SAS version 9.2. Results We identified 348 patients who represent 3.03 million community-dwelling schizophrenia patients in the USA between 2005 and 2008. The estimated direct cost from 2005–2008 was US$17.1 billion, or approximately US$4 billion per year, with a mean annual cost per patient of US$5984. The indirect costs over the same 4-year period amounted to US$74.74 billion, or approximately US$18.68 billion per year, with a mean annual cost per patient of US$24 664. Assuming equal utilization each year, the annual total costs were approximately US$23 billion. Discussion The financial burden imposed by schizophrenia was disproportionately high. The mean annual prevalence of schizophrenia in the community was about 0.25% while the annual costs were about US$23 billion.

Identifying patient characteristics associated with high schizophrenia-related direct medical costs in community-dwelling patients.

Schizophrenia is a chronic, debilitating disease that affects approximately 1% of the U.S. population and has disproportionately high costs. Several factors, including age, gender, insurance status, and comorbid conditions, have been hypothesized to be associated with schizophrenia- related costs. To identify demographic and clinical characteristics of community-dwelling schizophrenia patients experiencing high schizophrenia-related direct medical costs. Community-dwelling patients with a diagnosis for schizophrenic disorder (ICD-9-CM code 295) and other nonorganic psychoses (ICD-9-CM code 298) were identified from the 2005-2008 Medical Expenditure Panel Survey (MEPS). Schizophrenia-related direct medical costs were calculated for (a) inpatient hospitalizations; (b) prescription medications; and (c) outpatient, office-based physician, emergency room, and home health care visits. Using Andersen's Behavorial Model of Health Services Use and the literature, factors that could potentially affect schizophrenia-related direct medical costs were identified. Based on the distribution of their mean annual costs, patients were classified into high- and low-cost groups. Logistic regression was used to determine the likelihood of high-cost group membership based on age, sex, race, insurance status, marital status, region of residence, family income as a percentage of poverty line, number of medical comorbidities, number of mental health-related comorbidities, patient-perceived general health status, patient-perceived mental health status, and year of inclusion in MEPS. In addition, a generalized linear model (GLM) regression (gamma distribution with a log-link function) was used to evaluate the relationships between the independent variables and total schizophrenia-related direct medical costs as a continuous variable. From the MEPS database, we identified 317 patients with schizophrenia who represented 2.75 million noninstitutionalized, community-dwelling schizophrenia patients in the United States between 2005 and 2008. The logistic regression procedure showed that older patients (OR=0.933, 95% CI=0.902-0.966) and patients with a spouse (OR=0.150, 95% CI=0.041-0.555) were less likely to be in the high-cost group, while those who reported having "poor" perceived general health status (OR=15.548, 95% CI=1.278-189.127) were more likely to be in the high-cost group. The GLM regression procedure showed that younger patients (compared with older patients), African Americans (compared with Caucasions), patients with private insurance (compared with the uninsured), and those living in the northeastern United States (compared with those living in the southern United States) had higher schizophrenia-related direct medical costs. Identification of factors associated with a high-cost population may help decision makers in managed care, government, and other organizations allocate resources more efficiently and health care providers manage patients more effectively through assignment of these patients to case managers and appropriate monitoring and treatment.

Suicide attempt and suicidal ideation and their associations with demographic and clinical correlates and quality of life in Chinese schizophrenia patients

This study aimed to examine the prevalence and correlates of lifetime suicide attempts and current suicidal ideation in community-dwelling schizophrenia patients in China. A sample of 540 schizophrenia patients was randomly selected in Beijing, China. All subjects were interviewed using standardized assessment instruments and their basic socio-demographic and clinical data including history of suicide attempts were collected. The prevalence of lifetime suicide attempts and the point prevalence of suicidal ideation were 12.0%, and 21.1%, respectively. In multiple logistic regression analyses, the presence of lifetime suicide attempt was independently associated with rural residence, having major medical conditions and better social functioning, while higher likelihood of current suicidal ideation was associated with past suicide attempt, the severity of overall psychopathology and depressive symptoms and lower psychological quality of life (QOL). Among Chinese outpatients with schizophrenia, increased current symptoms and poorer QOL were correlated with current suicidal ideation, while demographic factors and indicators of greater social support were mostly correlated with lifetime suicide attempts. This study may help to identify important subgroups of patients with schizophrenia at particularly high risk of suicidal behavior.

Quality of Life in Community-Dwelling Patients With Schizophrenia in China

The aim of this study was to assess Chinese schizophrenia patients' quality of life (QOL) and identify its demographic and clinical correlates. A random sample of 540 community-dwelling schizophrenia patients was interviewed using standardized assessment instruments. The patients' basic sociodemographic and clinical data and QOL were collected. Compared with the general population, patients had significantly lower scores in the physical and psychological QOL domains. Multivariate analyses showed that better social support independently predicted higher QOL in all domains, whereas more severe positive symptoms predicted worse psychological and environmental domains. Overall psychopathology predicted both worse physical and psychological domains; depressive symptoms and being married predicted worse physical and social QOL, respectively. Our results suggest that therapeutic and psychosocial interventions alleviating positive and depressive symptoms and improving poor social support and marriage-related problems in Chinese patients with schizophrenia might be of considerable benefit in improving their QOL.

Low cardiorespiratory fitness and physical functional capacity in obese patients with schizophrenia

Background Low cardiorespiratory fitness is a prominent behavioral risk factor for cardiovascular disease (CVD) morbidity and mortality, as cardiorespiratory fitness is strongly associated with CVD outcomes. High rates of CVD have been observed in the schizophrenia population, translating into a markedly reduced life expectancy as compared to healthy controls. Surprisingly however, while cardiorespiratory fitness is an eminent indicator for overall cardiovascular health as well as eminently modifiable risk factor for CVD, no studies have systematically assessed cardiorespiratory fitness in schizophrenia. Methods Community-dwelling schizophrenia patients underwent graded-exercise tests, to ascertain maximal oxygen uptake (Max Vo2), considered to be the gold standard for the evaluation of cardiorespiratory fitness and physical functional capacity. The modified Bruce protocol was used to ascertain cardiorespiratory fitness and physical functional capacity; data was normalized and compared to population standards derived from the ACLS (Aerobics Center Longitudinal Study) and the National Health and Nutrition Examination Surveys (NHANES), Cycles III and IV. Results Data for n = 117 participants (41% male, 46% white) was analyzed. Mean age (y) was 43.2 ± 9.9, and mean BMI was 37.2 ± 7.3. Peak HR attained during exercise was 145.6 ± 19.6, after 8.05 ± 3.6 min, achieving 111.2 ± 44.2 W. Max Vo2 was 1.72 ± 6.6 l/min, MaxVCo2 1.85 ± 7.2 l/min, and minute ventilation (VE) was 55.6 ± 21.9 ml/s. PANSS Positive subscores (13.3 ± 4.4; r = −0.21, p = 0.024 ) were inversely correlated with Max Vo2 ml − 1 min − 1 kg − 1 . Neither PANSS Total (56.3 ± 12.3; r = −0.105, p = 0.72 ), PANSS Negative (14 ± 5.1; r = −0.52, p = 0.57 ) nor PANSS General Psychopathology (28.4 ± 7.4; r = −0.28, p = 0.76 ) scores were correlated with Max Vo2 ml − 1 min − 1 kg − 1 . Peak heart rate and duration of exercise were not correlated with PANSS scores. Compared to healthy controls derived from the ACLS and NHANES, respectively, 115 participants achieved ‘low levels’ of fitness only, as well as highly significantly reduced Max Vo2, across all age groups. Conclusion The test was generally well received and tolerated by those who elected to participate; and adherence to the protocol was good. Among participants with schizophrenia, most of whom were obese, and across all age groups, cardiorespiratory fitness was exceedingly poor. Only two participants in our entire sample fit the categorization of ‘moderate fitness level’; that is, a fitness level at or above the 20th percentile of ACLS-derived population comparisons. Conversely, this left 98.3% of participants with schizophrenia below population standards. Low cardiorespiratory fitness emerges as an eminent modifiable risk factor for CVD mortality and morbidity in schizophrenia complicated by obesity.