Hodgins Sheilagh, Lincoln Tania, Mak Tim
Institute of Psychiatry, King's College London, PO23, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
Soc Psychiatry Psychiatr Epidemiol. 2009 Jun;44(6):448-57. doi: 10.1007/s00127-008-0460-8. Epub 2008 Nov 22.
The present study aimed to identify proximal and distal factors associated with real life community functioning among men with schizophrenia. Real life community functioning was defined to include: independent living, occupational functioning, social and leisure activities, and substance misuse, self-harm, and aggressive behaviour.
225 men with schizophrenia or schizo-affective disorder were assessed at discharge from hospital and at six-monthly intervals during a two-year period. Information was available from structured interviews with the participants, family members and treatment staff, records of psychiatric treatment, social service files, and official criminal records. Symptoms were assessed using the Positive and Negative Symptom Scale and the Hamilton Rating Scale for Depression. Substance misuse was measured by self-report and hair and urine analyses. Predictors of outcome were divided into four categories: childhood, adulthood, year prior to functional outcome assessment, and con-current.
In a final regression model, five predictors were significantly associated with patients' real life functioning: two adult life-time variables-a diagnosis of drug abuse/dependence and level of education and three current variables-victimisation, depression, and medication non-compliance. Most of the variance in the final outcome scores was explained by current predictors.
In order to elevate levels of psychosocial functioning among men with schizophrenia, clinicians need to assess victimisation experiences, and, when present, design and implement interventions to help patients protect themselves. In addition, depression needs to be identified and treated, and compliance with antipsychotic medication assured.
本研究旨在确定与精神分裂症男性患者现实生活社区功能相关的近端和远端因素。现实生活社区功能的定义包括：独立生活、职业功能、社交和休闲活动，以及药物滥用、自我伤害和攻击行为。
对225名患有精神分裂症或分裂情感性障碍的男性患者在出院时以及在两年期间每六个月进行一次评估。通过对参与者、家庭成员和治疗人员的结构化访谈、精神科治疗记录、社会服务档案以及官方犯罪记录获取信息。使用阳性和阴性症状量表以及汉密尔顿抑郁评定量表评估症状。通过自我报告以及毛发和尿液分析来测量药物滥用情况。将结果的预测因素分为四类：童年、成年、功能结局评估前一年以及当前。
在最终回归模型中，有五个预测因素与患者的现实生活功能显著相关：两个成年期终生变量——药物滥用/依赖诊断和教育水平，以及三个当前变量——受侵害情况、抑郁和药物治疗不依从。最终结局分数的大部分变异由当前预测因素解释。
为了提高精神分裂症男性患者的心理社会功能水平，临床医生需要评估受侵害经历，如有此类经历，需设计并实施干预措施以帮助患者保护自己。此外，需要识别并治疗抑郁，确保患者遵医嘱服用抗精神病药物。
