Wheeler Amanda
Clinical Research and Resource Centre, Snelgar Building, Waitakere Hospital, Auckland, Waitakere, New Zealand.
Aust N Z J Psychiatry. 2007 Oct;41(10):809-18. doi: 10.1080/00048670701579066.
To describe the demographic, social and functional characteristics and service utilization of people with schizophrenia attending four public psychiatric services in New Zealand and to compare this with (i) people with severe affective disorders attending the same four services and (ii) the New Zealand general population; and to examine conformity with evidence-based pharmacological treatment of schizophrenia.
Clinical files for all adult outpatients attending the four specialist services were reviewed in October 2004 (n =6164). Patient characteristics, social and functional indicators, diagnosis, duration of illness, and admission information were recorded and analysed for schizophrenia, bipolar disorder and depression (n =5032). Antipsychotic treatment was recorded for those with schizophrenia.
Outpatients with schizophrenia made up 47% of the outpatient population; 66% were male, the mean age 39 years and the mean illness duration was 14 years. Sixty-seven percent of schizophrenia outpatients had never been married, 69% had no regular occupational activity, 49% had no formal qualifications, 24% were living in group homes and 26% were treated compulsorily. These characteristics were consistently different compared to outpatients with severe affective disorders and the general population; schizophrenia patients were the most impaired, depression the least and the bipolar group in between. The majority of schizophrenia patients received evidence-based antipsychotic treatment; 84% received monotherapy; 81% prescribed an atypical; 33% prescribed clozapine.
The study shows significant impairment for schizophrenia patients in areas of intimate relationships, occupational activity, living situation, qualifications and specialist mental health service use despite evidence-based pharmacological treatment. To improve outcome optimal care must incorporate existing evidence-based, cost-effective interventions that focus on both symptoms and function. More effective treatments also need to be developed.
描述在新西兰四家公立精神科服务机构就诊的精神分裂症患者的人口统计学、社会和功能特征以及服务利用情况，并将其与（i）在相同四家服务机构就诊的重度情感障碍患者以及（ii）新西兰普通人群进行比较；并检查精神分裂症的循证药物治疗的依从性。
2004年10月对在这四家专科服务机构就诊的所有成年门诊患者的临床档案进行了审查（n = 6164）。记录并分析了精神分裂症、双相情感障碍和抑郁症患者（n = 5032）的患者特征、社会和功能指标、诊断、病程以及入院信息。记录了精神分裂症患者的抗精神病药物治疗情况。
精神分裂症门诊患者占门诊患者总数的47%；66%为男性，平均年龄39岁，平均病程为14年。67%的精神分裂症门诊患者从未结婚，69%没有固定职业活动，49%没有正规学历，24%住在集体宿舍，26%接受强制治疗。与重度情感障碍门诊患者和普通人群相比，这些特征始终存在差异；精神分裂症患者受损最严重，抑郁症患者受损最轻，双相情感障碍组居中。大多数精神分裂症患者接受了循证抗精神病药物治疗；84%接受单一疗法；81%使用非典型药物；33%使用氯氮平。
该研究表明，尽管有循证药物治疗，但精神分裂症患者在亲密关系、职业活动、生活状况、学历和专科心理健康服务利用等方面存在明显损害。为了改善治疗结果，最佳护理必须纳入现有的循证、具有成本效益的干预措施，这些措施既要关注症状，也要关注功能。还需要开发更有效的治疗方法。
