Yong-Zhen Weng

Subjective quality of life in outpatients with schizophrenia in Hong Kong and Beijing: relationship to socio-demographic and clinical factors

PurposeThis study compared the subjective quality of life (SQOL) in schizophrenia patients living with their families in Hong Kong (HK) and Beijing (BJ) and explored the relationship between SQOL and basic socio-demographic and clinical factors.Materials and methodsTwo hundred and sixty-four clinically stable outpatients with schizophrenia were randomly selected in HK and 258 counterparts matched according to age, sex, age at onset, and length of illness in BJ. SQOL and psychiatric status were assessed with standard rating instruments.ResultsThere was no significant difference in any of SQOL domains between the two cohorts after controlling for potentially confounding variables. Positive, depressive and anxiety symptoms and drug-induced extrapyramidal side effects (EPS) were all significantly correlated with SQOL. Multiple regression analysis revealed that only depressive symptoms predicted all SQOL domains in both groups. Having removed depressive symptoms from the model, positive symptoms predicted all domains, anxiety predicted all but social domains, use of benzodiazepines (BZD) predicted all but physical domains, EPS predicted physical domain, and history of suicide predicted social domain in HK; anxiety predicted all domains, positive symptoms predicted all but physical domains, EPS, use of BZD and history of suicide all predicted physical domains, and length of illness predicted environmental domain in BJ.ConclusionDespite considerable differences between the two sites in terms of health care delivery and the economic conditions of the subjects, SQOL did not differ between HK and BJ. The conclusion is in line with previous studies that suggested that patients’ SQOL was independent of their living standard as long as it reached a certain minimum level. SQOL was more strongly related to the severity of depressive symptoms and had weak association with socio-demographic factors.

Quality of Life of Chinese Schizophrenia Outpatients in Hong Kong: Relationship to Sociodemographic Factors and Symptomatology

Objective: To explore the relationships between sociodemographic and clinical factors and quality of life (QOL) in a cohort of Chinese schizophrenia outpatients. Method:Two hundred subjects with a diagnosis of DSM-IV schizophrenia aged 18–60 years were randomly selected, and their sociodemographic and clinical characteristics including psychotic and depressive symptoms, extrapyramidal symptoms (EPS), and quality of life were assessed. Correlation and multiple regression analyses were used to evaluate the relationships of sociodemographic, clinical data and QOL. Results: Compared to normative data obtained for the general population in Hong Kong, significantly lower scores in physical, psychological, and social QOL domains were found in the patient group. History of suicidal attempts and the presence of positive, negative, depressive, anxiety and EPS symptoms were all significantly correlated with QOL in schizophrenia patients. After controlling for the effects of variables that were significantly correlated with QOL in the correlation analysis, however, only depressive symptoms were still significantly correlated with each QOL domain. Multiple regression analysis showed that depressive symptoms predicted all QOL domains, while positive symptoms predicted overall and physical QOL domains. Conclusions: Chinese outpatients with schizophrenia had poorer QOL than the general population. In this patient population, QOL was more strongly related to the severity of depressive symptoms and was independent of sociodemographic factors.

Risperidone Maintenance Treatment in Schizophrenia: A Randomized, Controlled Trial

OBJECTIVE Prevention of relapse is the crucial task in the maintenance treatment of schizophrenia. The investigators in this study sought to determine the duration of maintenance treatment needed with the initial therapeutic dose, in contrast to a reduced dose. METHOD In a multicenter open-label, randomized, controlled study, patients with schizophrenia who were clinically stabilized following an acute episode were randomly assigned to a no-dose-reduction group (initial optimal therapeutic dose continued throughout the study), a 4-week group (initial optimal therapeutic dose continued for 4 weeks, followed by a 50% dose reduction that was maintained until the end of the study), or a 26-week group (initial optimal therapeutic dose continued for 26 weeks, followed by a 50% dose reduction until the end of the study). All patients continued until the last recruited patient completed the 1-year follow-up. RESULTS Of the 404 patients who met the entry criteria and were randomly assigned, 374 completed the study. The estimated mean time from entry to relapse was 571 days in the 4-week group, 615 days in the 26-week group, and 683 days in the no-dose-reduction group, with estimated relapse rates of 30.5%, 19.5%, and 9.4%, respectively. Patients in the no-dose-reduction group experienced greater reduction in the severity of psychotic symptoms. CONCLUSIONS Patients who continued to receive the full risperidone dose used for their acute episode had fewer relapses than those who had dose reductions after 4 weeks or 26 weeks during the maintenance period. There was negligible difference in side effects among the three groups.

Training patients with schizophrenia with the community re-entry module : A controlled study

BackgroundThere is increasing evidence indicating that the Community Re-entry Module (CRM), a brief, structured instrument, could guide an effective intervention for patients with schizophrenia. This study evaluated the effectiveness of the Chinese version of the CRM with respect to improvement in psychiatric symptoms, social functioning as well as relapse and re-hospitalization rates in comparison with a supportive counseling (SC) intervention.MethodNinety-six outpatients with DSM-IV schizophrenia were randomly allocated to either CRM (N=48) or an equally intensive intervention of SC (N=48). The CRM was composed of 16 one-hour sessions, which were conducted with groups of 6–8 patients on a twice-a-week schedule. The two groups received routine psychiatric outpatient care during the intervention. Participants were assessed on an intention-to-treat basis with the Positive and Negative Syndrome Scales (PANSS), with the Social Disability Screening Schedule (SDSS) by two independent raters before and immediately after intervention, and at 6-month follow-up. The number of relapse and re-hospitalization were also documented.ResultsThe CRM group significantly improved in terms of psychiatric symptoms and social functioning compared with the SC group. Rates of relapse and re-hospitalization in the CRM group were lower although the difference between the two groups was not statistically significant.ConclusionsThe study supports the feasibility and effectiveness of the Chinese version of the CRM as an effective psychosocial intervention for Chinese patients with schizophrenia to improve psychopathology, social functioning and relapse and re-hospitalization rates.

Cigarette smoking in patients with schizophrenia in China: prospective, multicentre study

Objective: The aim of the present study was to explore the rate of cigarette smoking and its sociodemographic and clinical characteristics in Chinese schizophrenia patients. Methods: In a multicentre, randomized, controlled, longitudinal study, 374 clinically stable patients with schizophrenia were interviewed at entry using standardized assessment instruments, and followed up for 1–2 years. Results: The rate of cigarette smoking was 13.9% in the whole sample, and 26.2% in men and 3.5% in women. On univariate analysis, male sex, unemployment, alcohol consumption, older age, older age at onset, longer duration of illness, more frequent admissions, more severe hostility–excitement at entry and less deterioration in hostility–excitement over the study period were significantly associated with cigarette smoking. On multivariate analysis, male sex, unemployment, alcohol consumption, more frequent admissions, less severe positive and negative symptoms at entry, smaller decline in negative symptoms and more deterioration in disorganized thoughts over the study period were independently associated with cigarette smoking. Conclusion: The rate of cigarette smoking in Chinese schizophrenia patients is considerably lower than most figures reported in the Western literature.

Sex differences in patients with schizophrenia: A prospective, multi-center study

This study aimed to determine sex differences in socio-demographic and clinical characteristics of Chinese schizophrenia patients. In a multi-center, randomized, controlled, longitudinal study, 404 clinically stable patients with schizophrenia were randomly assigned to a maintenance group (optimal therapeutic doses continued throughout the study), a 26-week group (optimal therapeutic doses continued for 26 weeks, followed by a 50% dose reduction maintained until the end of the study), or a 4-week group (optimal therapeutic doses continued for 4 weeks, followed by a 50% dose reduction maintained until the end of the study). Participants were interviewed regularly using standardized assessment instruments, and followed up for 12-26 months. In the univariate analyses, the following factors were significantly associated with the male sex: not married, smoking, younger age, earlier age at onset, higher body mass index (BMI) at baseline, and more severe negative and hostility-excitement symptoms at baseline. The following factors were independently associated with the male sex in the multivariate analyses: not being married, smoking, a higher BMI at baseline, less deterioration in disorganized thoughts (4-week group) and positive symptoms (26-week group) and less increase in BMI in all three treatment groups over the study period. The majority of the sex differences in schizophrenia patients in this study are in accordance with results of previous studies worldwide suggesting that sex differences seen in schizophrenia are not dependent on cultural differences between geographically separate patients.

Impact of sociodemographic and clinical factors on subjective quality of life in schizophrenia patients in Beijing, China.

The impact of sociodemographic and clinical factors on subjective quality of life (SQOL) in Chinese schizophrenia outpatients was explored. Randomly selected subjects with schizophrenia (N = 273) were assessed with respect to their sociodemographic, clinical characteristics, and SQOL. Compared with the Chinese general population, patients had significantly lower scores in the physical and social SQOL domains. Multiple regression analyses revealed that depressive symptoms inversely predicted all SQOL domains; positive symptoms negatively predicted psychological, social, and environmental SQOL domains whereas educational level, extrapyramidal side effects, anxiety, history of suicide attempts, employment status, monthly income, number of hospitalization, and length of illness all significantly contributed to 1 or 2 SQOL domains.

Gender differences in sociodemographic and clinical characteristic and the quality of life of Chinese schizophrenia patients

Objective: The aim of the present study was to determine the sociodemographic and clinical correlates of the gender of Chinese schizophrenia outpatients and their impact on patients quality of life (QOL). Methods: Two hundred and fifty-five clinically stable schizophrenia outpatients were randomly selected in Hong Kong. Counterparts matched according to gender, age, age at onset, and length of illness were recruited in Beijing, China. All of the subjects at both sites were interviewed by the same investigator using standardized assessment instruments. Results: The combined Beijing–Hong Kong sample contained 251 male and 254 female patients. On univariate analysis more male patients were employed, they had a significantly higher monthly income, and took higher doses of antipsychotic drugs. No difference was found, however, in any of the QOL domains between the genders. On multivariate analysis being employed, taking a higher dose of antipsychotic drugs, having more severe extrapyramidal side-effects, and a higher score on the physical domain of QOL were independently associated with male gender. Conclusion: Female gender is independently associated with lower scores on the physical aspects of QOL, but there is no difference between the genders in the psychological, social and environmental aspects.

Clinical and social determinants of psychotropic drug prescription for schizophrenia outpatients in China

To date, few studies have investigated prescription patterns of psychotropic drugs in Chinese patients with schizophrenia in general and outpatients in particular. This study examined the role that socio-demographic and clinical factors play in determining psychotropic drug prescriptions for schizophrenia outpatients in China. Two hundred and fifty-five and 250 clinically stable outpatients with schizophrenia were randomly selected and interviewed in Hong Kong (HK) and Beijing (BJ) respectively, using standardized assessment instruments. Prescriptions of psychotropic drugs for all 505 subjects were collected at the time of the assessment. The relationship between antipsychotic drug prescription patterns and a host of socio-demographic and clinical variables was analyzed and compared between the two study sites. Prescription patterns were quite different for the two ethnically homogenous and clinically very similar samples. In multiple logistic regression analyses, the use of depot antipsychotics (DA) and site (HK vs BJ) both significantly predicted antipsychotic polypharmacy (APP), while symptoms of anxiety, use of clozapine and APP and site predicted use of DA. Age, number of hospitalizations, site, and use of DA predicted use of clozapine. No significant differences were found between the quality of life domains of patients with respect to APP, DA, and clozapine. A complex web of economic and clinical factors and health policies plays an important role in determining psychotropic drug prescription practices for Chinese outpatients with schizophrenia.

Socio-demographic and clinical profiles of paranoid and nonparanoid schizophrenia: a prospective, multicenter study in China.

PURPOSE This study aimed to explore the socio-demographic and clinical characteristics of paranoid and nonparanoid subtypes of schizophrenia. DESIGN AND METHODS In a multicenter, randomized, controlled, longitudinal study, 374 clinically stable schizophrenia patients were interviewed at entry with standardized assessment instruments and followed for 12-26 months. FINDINGS In the multivariate analysis, male sex, married marital status, urban abode, and more frequent relapse over the study period were independently associated with paranoid schizophrenia. PRACTICE IMPLICATIONS The socio-demographic and clinical characteristics of Chinese patients with the paranoid subtype of schizophrenia are different from those of their Caucasian counterparts who are more likely to be women and have a better outcome.