Schizophrenia Patients In China Research Articles

Factors related to suicidal ideation of schizophrenia patients in China: a study based on decision tree and logistic regression model

ABSTRACT This study aimed to investigate the factors associated with suicidal ideation in schizophrenia patients in China using decision tree and logistic regression models. From October 2020 to March 2022, patients with schizophrenia were chosen from Chifeng Anding Hospital and Daqing Third Hospital in Heilongjiang Province. A total of 300 patients with schizophrenia who met the inclusion criteria were investigated by questionnaire. The questionnaire covered general data, suicidal ideation, childhood trauma, social support, depressive symptoms and psychological resilience. Logistic regression analysis revealed that childhood trauma and depressive symptoms were risk factors for suicidal ideation in schizophrenia (OR = 2.330, 95%CI: 1.177 ~ 4.614; OR = 10.619, 95%CI: 5.199 ~ 21.688), while psychological resilience was a protective factor for suicidal ideation in schizophrenia (OR = 0.173, 95%CI: 0.073 ~ 0.409). The results of the decision tree model analysis demonstrated that depressive symptoms, psychological resilience and childhood trauma were influential factors for suicidal ideation in patients with schizophrenia (p < 0.05). The area under the ROC for the logistic regression model and the decision tree model were 0.868 (95% CI: 0.821 ~ 0.916) and 0.863 (95% CI: 0.814 ~ 0.912) respectively, indicating excellent accuracy of the models. Meanwhile, the logistic regression model had a sensitivity of 0.834 and a specificity of 0.743 when the Youden index was at its maximum. The decision tree model had a sensitivity of 0.768 and a specificity of 0.8. Decision trees in combination with logistic regression models are of high value in the study of factors influencing suicidal ideation in schizophrenia patients.

Weight changes following treatment with aripiprazole, risperidone and olanzapine: A 12-month study of first-episode schizophrenia patients in China.

This study aimed to assess weight changes following antipsychotic treatment in first-episode schizophrenia (FES) patients and make a comparison of aripiprazole, risperidone and olanzapine. Predictors for long-term clinically relevantweight gain (CRW, ≥7%) were examined. We carried out a second analysis of data from the Chinese First-Episode Schizophrenia Trial. Repeated measures general linear model (GLM) statistics were used to compare body weight at each follow-up point (month of 1, 2, 3, 6, 9and 12). Logistic regression models were constructed to evaluate possible predictors for CRW. Body weight increased with an average rate of 0.93 % per month, with the fastest growth rate occurring in first 3 months. CRW was observed in 79 % of patients. Participants from olanzapine group showed significantly higher weight gain than risperidone group and aripiprozole group. Repeated measures GLM revealed a significant main effect of time (p<0.001) and asignificant time*group interaction was revealed (p<0.001), while the between-subjectgroup effect was not statistically significant (p=0.272). Multivariate logistic regressionmodel showed that with smaller baseline BMI (OR = 1.33, p<0.001), with a family historyof mental disorder (OR = 5.08, p=0.004), receiving olanzapine (OR = 2.35, p=0.001), and CRW at first-month (OR = 4.29, p=0.032) were independent predictors for first-year CRW. Antipsychotics are associated with a clinically significant weight gain in FES patients, which occurs mostly in first 3 months. Aripiprazole might not be an ideal choice in terms of long-term metabolic side-effects. Early and close metabolicmonitoring should accompany antipsychotic prescription.

Characteristics associated with registration and management of the 686 Program among schizophrenia patients in China: A cross-sectional study.

The 686 Program has covered mainland China but lacks empirical research. We aimed to examine potential influencing factors associated with the registration and management of the Program. 3993 patients with schizophrenia discharged in 2019 were included. We found that approximately two-thirds of patients were registered. 88.9 % registered patients accepted the follow-up management. Males, unemployment, lower education, longer duration of illness, more hospitalization positively affected the registration and management. Individuals with violent behavior and local Hukou were more likely to be registered. Future evaluation of the Program should take these factors into account.

Metacognitive training: a useful complement to community-based rehabilitation for schizophrenia patients in China

BackgroundThe traditional general practitioner-based model (community-based rehabilitation [CBR]) for Chinese schizophrenia patients lacks sufficient content, usefulness, and theoretical basis for rehabilitation. Based on previous research, we postulate that Metacognitive Training (MCT) is effective in the community for schizophrenic patients.MethodA randomized controlled, assessor-blinded trial was conducted. A total of 124 schizophrenia patients were recruited from Ningbo China and were randomly assigned to an intervention or a control group. A general practitioner (GP) training plan was carried out before intervention. Intervention and control groups received two CBR follow-ups once a month, while the intervention group, received an additional eight once-a-in-week session of MCT. The Positive and Negative Syndrome Scale (PANSS), and the Psychotic Symptom Rating Scales (PSYRATS) were the primary outcome instruments, while the Quality of Life Scale (SQLS) was the secondary outcome instrument.ResultsIn the post-treatment between-groups assessment, the patients in the intervention group showed significantly more reductions on PSYRATS delusions, PSYRATS total, PANSS P6, PANSS core delusions, PANSS positive, PANSS negative, PANSS general and PANSS total, and a significant improvement in SQLS psychosocial aspect.ConclusionsThe study provides preliminary evidence for the usefulness of MCT as a complementary measure for community-based rehabilitation of schizophrenia patients.Trial registrationISRCTN, ISRCTN17333276. Registered 09 August 2020 - Retrospectively registered.

Comparative cost-effectiveness of amisulpride and olanzapine in the treatment of schizophrenia in China

ABSTRACT Background Both amisulpride and olanzapine are leading treatments for schizophrenia in China. This study aimed to investigate the long-term cost-effectiveness of amisulpride and olanzapine in the treatment of schizophrenia in China. Methods A decision-analytic Markov model was developed to simulate the lifetime clinical and economic outcomes of schizophrenia treatment from the healthcare payer perspective. The long-term costs and QALYs were estimated. Sensitivity analyses were performed to explore the impact of variance of parameters on the results. Results Treatment with amisulpride provided an effectiveness gain of 16.59 QALYs at an average cost of USD 25,884 whereas olanzapine resulted in 16.38 QALYs at a cost of USD 34,839 over a lifetime horizon. One-way sensitivity analysis suggested that the most sensitive variable was the unit cost of olanzapine. In a probabilistic sensitivity analysis based on a Monte Carlo simulation with a lifetime horizon, the probability of amisulpride being cost-effective was 99.8% at a willingness-to-pay threshold of USD 9,322, the GDP per capita in China 2018. A scenario analysis with updated olanzapine unit cost suggested an ICER of 7,857 USD/QALY. Conclusions Amisulpride is likely to be a cost-effective option with increased effectiveness compared with olanzapine in the treatment of schizophrenia patients in China.

The factors associated with depression in schizophrenia patients: the role of self-efficacy, self-esteem, hope and resilience

ABSTRACTPrevious studies have shown a significant correlation between depression, resilience, self-efficacy, self-esteem and hope among schizophrenia patients, but few studies have examined the mechanisms among these factors. This study aimed to analyse the relationships among resilience, self-efficacy, self-esteem and hope as influencing factors of depression in schizophrenia patients. A cross-sectional study was conducted, and 361 schizophrenia patients were recruited. They were interviewed about their self-efficacy, self-esteem, hope, resilience and depressive symptoms. A structural equation model was used to examine the direct and indirect associations between them. The global model showed good model fit and the structural equation model revealed that the direct pathway of resilience on depression was significant, and the indirect pathway of self-efficacy, self-esteem and hope on depression via resilience was also significant. Notably, self-efficacy, self-esteem and hope did not directly affect depressive symptoms. These findings support the mediating model of self-efficacy, self-esteem and hope relevant to the depressive symptoms of schizophrenia patients in China, in which resilience plays a pivotal role. These findings elucidate the factors which may be associated with depressive symptoms and imply that enhancing resilience in people with schizophrenia could be beneficial. Moreover, studies with detailed longitudinal assessments are necessary to confirm these findings.

Quality of life in Chinese patients with schizophrenia: A meta-analysis

The impact of schizophrenia on quality of life (QOL) is significantly influenced by sociocultural factors. This meta-analysis systematically compared QOL between patients with schizophrenia and healthy controls in China. PubMed, PsycINFO, Embase, Chinese National Knowledge Infrastructure (CNKI), SinoMed and WanFang databases were searched to identify case-control studies. Standardized mean differences (SMDs) and 95% confidence interval (CI) were calculated using random effect models. Eighteen case-control studies comparing QOL between schizophrenia patients (n = 2,425) and healthy controls (n = 2,072) were included in the analyses. Compared with healthy controls, schizophrenia patients had significantly poorer overall QOL [11 studies; SMD:-1.07 (95%CI:-1.44, -0.70), P < 0.001] as well as in the physical, psychological, social and environmental QOL domains. Subgroup analyses revealed that poorer QOL was significantly associated with diagnostic criteria, study location, female gender, older age and inpatient status. Older schizophrenia patients had lower physical and psychological QOL, while inpatients had lower psychological QOL. In conclusion, compared with healthy controls, schizophrenia patients in China have significantly lower QOL.

Prevalence and risk factors of agitation in newly hospitalized schizophrenia patients in China: An observational survey

This multi-center observational study investigated the prevalence of agitation in newly hospitalized schizophrenia patients in China and its potential risk factors. It was performed in 2014 and covered 14 hospitals. Newly hospitalized patients with schizophrenia or suspected schizophrenia who met the diagnostic criteria of the International Statistical Classification of Diseases and Related Health Problems, 10th revision, were recruited. Agitation and related risk factors were evaluated by a questionnaire designed for the survey. General demographic data, disease characteristics, scores on schizophrenia rating scales and agitation rating scales (e.g., Positive and Negative Syndrome Scale-Excited Component [PANSS-EC] and Behavioral Activity Rating Scale [BARS]) were collected. Among the 1512 patients screened in the study, 1400 (92.59%) were eligible. According to the PANSS-EC and BARS, the prevalence of agitation was 60.92% (853 of 1400) and 59.00% (826 of 1400), respectively. The overall prevalence of agitation was 47.50% (665 of 1400). The most important risk factor of agitation was being aggressive at baseline (Modified Overt Aggression Scale score ≥4, odds ratio=6.54; 95% confidence interval=4.93–8.69). Other risk factors included a history of aggressive behavior, northern region of residence, involuntary hospitalization, disease severity, low level of education, living alone, being unemployed or retired.

Serologic and molecular characteristics of hepatitis B virus infection in vaccinated schizophrenia patients in China.

Previous studies have indicated that the patients with psychiatric illness were at higher risk of hepatitis B virus (HBV) infection. However, the efficacy of hepatitis B vaccine in schizophrenia patients remains unclear. Between June 2014 and January 2015, 415 schizophrenia patients and 3,038 controls who had been routinely immunized as infants were recruited in the present study. Hepatitis B surface antigen (HBsAg), HBsAb, and HBV DNA were detected with commercial methods according to the manufacturer's protocol. A 600-bp region of the S gene (region nt236-nt835) was amplified by nested polymerase chain reaction (PCR). The genotypes of isolated HBV were identified using phylogenetic analysis by the neighbor-joining algorithm in the software MEGA version 4.1. The seroprevalence of HBsAg in schizophrenia patients was 6.75%, which was significantly higher than 3.32% measured in controls. HBsAg prevalence was 7.94% in male schizophrenia patients and 5.47% in female schizophrenia patients, while it was only 4.04% in males and 2.08% in females in the control group. The HBsAb seroprevalence rate was 58.31% in schizophrenia patients and 59.94% in non-schizophrenia controls. Moreover, one HBV strain in the schizophrenia group presented I126S vaccine escape mutation (5.88%), while three HBV isolates showed Q129H, M133L, and G145R vaccine escape mutations in the control group (6.81%). Schizophrenia patients are at higher risk for HBV infection, even those who had received routine immunization. Therefore, a booster HB vaccination targeted at schizophrenia patients should be considered in the future.

Population pharmacokinetic-pharmacodynamic (PopPK/PD) modeling of risperidone and its active metabolite in Chinese schizophrenia patients.

Risperidone is a second-generation antipsychotic agent commonly used in the treatment of ~ 31.1% of schizophrenia patients in China, it is the most commonly-prescribed antipsychotic agent. Despite the abundant use of risperidone, population pharmacokinetic-pharmacodynamic models of risperidone have not been performed in Chinese schizophrenia patients. The objective of this study was to develop a population pharmacokinetic-pharmacodynamic (PopPK/PD) model to describe the PK behavior and efficacy of risperidone and 9-hydroxy-risperidone (active metabolite) in Chinese patients. Plasma concentration data (702 measurements from 131 patients) and positive and negative syndrome scale (PANSS) scores (258 observations from 56 patients) were analyzed using a nonlinear mixed-effects modeling (NONMEM) approach with first-order conditional estimation with interaction (FOCEI). The influence of potential covariates was evaluated. Model robustness was assessed using external validation, normalized prediction distribution error, nonparametric bootstrap, and visual predictive check approaches. Risperidone concentration data were well described by a one-compartmental model incorporating an additional compartment that refers to the concentration profiles of 9-hydroxy-risperidone. A complex absorption procedure was incorporated into the model to describe the metabolism of risperidone to 9-hydroxy-risperidone in the gastrointestinal (GI) tract. A binomial distribution in the estimated clearance (CL) of risperidone has been identified in our model. Decrease in PANSS score along with total AUC (AUCtotal) of risperidone and 9-hydroxy-risperidone was best characterized by an Emax model with 3 transit compartments describing the delay of drug effect. Considerable differences in PK behavior and drug effect of risperidone have been identified among Chinese extensive metabolizing (EM) and poor metabolizing (PM) patients. This PopPK/PD model may fulfill individualized treatment in clinical practice and may potentially be transferred to other antipsychotic therapies.

Clozapine in schizophrenia and its association with treatment satisfaction and quality of life: Findings of the three national surveys on use of psychotropic medications in China (2002–2012)

ObjectiveWe examined the time trends and correlates of clozapine use in schizophrenia patients in China. MethodA total of 14,013 patients with schizophrenia treated in 45 psychiatric hospitals/centers nationwide were interviewed in 2002, 2006 and 2012. Patients' socio-demographic and clinical characteristics including psychopathology, medication side effects, satisfaction with treatment and quality of life (QOL) were recorded in a standardized fashion. ResultsClozapine was used in 32.9% of the whole sample; with corresponding figures of 39.7%, 32.5% and 26.4% in 2002, 2006 and 2012 (p<0.001). Families of clozapine users had lower satisfaction with treatment than those of the non-clozapine group, without significant differences with respect to patients' treatment satisfaction and mental or physical QOL. In multiple logistic regression analyses, compared to the non-clozapine group, patients on clozapine had an earlier age of onset, longer illness duration, more global illness severity and drug-induced central nervous system, gastrointestinal and other side effects, lower antipsychotic doses, less delusions and hallucinations, more negative symptoms, were more likely male, inpatients, to have a family history of psychiatric disorders, receive treatments in regional centers and receive antipsychotic polypharmacy, but less likely to have health insurance and receive first-generation antipsychotics and benzodiazepines (R2=0.498, p<0.001). ConclusionsClozapine was used in one-third of schizophrenia patients in China, with decreasing frequency since 2002. Patients prescribed clozapine had multiple markers of greater global illness severity/chronicity and decreased satisfaction with treatment by the families, but similar QOL and less delusions and hallucinations than patients not prescribed clozapine.

Antipsychotic polypharmacy in schizophrenia patients in China and its association with treatment satisfaction and quality of life: findings of the third national survey on use of psychotropic medications in China.

This study examined the use, demographic and clinical correlates of antipsychotic polypharmacy (APP) and its associations with treatment satisfaction and quality of life (QOL) in schizophrenia patients in China. A total of 4239 patients in 45 nationwide Chinese psychiatric hospitals/centers were interviewed in 2012 in the third cross-sectional study, with the first two having been conducted in 2002 and 2006. Patients' socio-demographic and clinical characteristics, including psychopathology, side effects, satisfaction with treatment and QOL, were recorded using a standardized protocol and data collection procedure. The proportion of APP prescriptions in 2012 was 34.2%, which was significantly higher than the frequency of APP in 2002 (26.1%) and 2006 (26.4%) (p<0.001). Of patients on APP, 91.1% received two antipsychotics, 8.6% received three and 0.3% received four or more antipsychotics. Multiple logistic regression analyses revealed that compared to those on antipsychotic monotherapy, patients on APP and their families had lower satisfaction with treatment, had higher QOL in the mental domain, younger age of onset, more side effects, higher doses of antipsychotics and were more likely to receive first-generation antipsychotics and less likely to receive benzodiazepines (total R (2)=0.31, p<0.001). APP was found in about one in three schizophrenia patients. The prevalence of APP seems to have been increasing since 2002. Considering the increased frequency of drug-induced side effects and the patients' and their relatives' dissatisfaction with antipsychotic treatment, further examination of the rationale and appropriateness of APP and its alternatives is warranted.

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.

The Transformation of China's Mental Health Services

Different powerful groups within a society characterize social deviance in different ways, so the types of social deviance considered 'mental disorders' are a reflection of the relative influence of different institutions in the community at a particular point in time. In most Western countries the influence of the medical establishment and the high profile of psychiatry within medicine result in a strong tendency to medicalize many forms of social deviance, to label them as mental disorders, and to develop corresponding treatment facilities. However, based on my observations during a dozen years as a practising psychiatrist in China, the medical institutions there are relatively weak — medical care only accounts for 3.2 per cent of GNP — and psychiatry has a very low status within medicine. The influence of medical and psychiatric institutions on the understanding and management of socially deviant behaviours is correspondingly small and the range of available mental health services is quite limited.