Treatment traits of acute schizophrenic inpatients with aggressive behaviors before admission

目的 了解院前发生攻击行为的急性精神分裂症患者住院治疗的临床干预措施和治疗效果的特点.方法 以151例急性精神分裂症新入院患者为研究对象,采用自编一般情况调查表和疾病信息调查表收集疾病相关信息,应用修订版外显攻击行为量表(MOAS)、阳性和阴性症状量表的兴奋因子(PANSS-EC)、行为活动评定量表(BARS)、风险评估量表、临床总体印象量表(CGI)评估其精神病理症状、护理风险和治疗效果,根据MOAS评分将研究对象分为攻击行为患者组和无攻击行为患者组,进行组间比较.结果 (1)151例患者中,入院前一周内有攻击行为者74例,无攻击行为者77例.(2)相对于无攻击行为患者组,攻击行为患者组既往有暴力/攻击史者比例较高,入院前1周未服药比例较高;入院时疾病严重程度较重,PANSS-EC、BARS和MOAS评分均较高;攻击风险和防攻击护理医嘱率较高,差异均有统计学意义(P<0.05);(3)两组患者入院时医生处方口服药物均为新型抗精神病药物,利培酮使用比例为68.9%,其次为奥氮平(13.2%)、喹硫平(5.3%),组间差异无统计学意义(P>0.05);攻击行为患者组氟哌啶醇注射率和保护性约束使用率明显高于无攻击行为患者组(P<0.05);(4)出院时,两组患者疾病严重程度、PANSS-EC评分、MOAS评分和出院疗效组间差异均无统计学意义(P>0.05).结论 院前发生攻击行为的急性期精神分裂症患者相对于无攻击行为者,住院治疗疗效相当,但入院时病情较重,较为兴奋激越,攻击风险和出走风险较高,住院期间肌肉注射抗精神病药物和保护性约束等措施应用较多.Objective To explore the characteristic of clinical interventions and treatment efficacy of acute schizophrenic inpatients with aggressive behaviors before admission. Methods Totals of 151 acute schizophrenic inpatients were recruited and divided into two groups (group A: patients with aggressive behaviors;group B: patients without aggressive behaviors) based on score of the Modified Overt Aggression Scale (MOAS). Disease information and clinical interventions were recorded using the self-made questionnaire. The aggressive behaviors occurred one week before the hospitalization,the agitation symptoms,the nurse risks,the severity and treatment efficacy of the subjects were evaluated using the Modified Overt Aggression Scale (MOAS),the Positive and Negative Syndrome Scale Excited Component (PANSS-EC),the scale of assessment on nurse risks and the Clinical Global Impression (CGI). Results (1) Of 151 inpatients,74 cases had aggressive behaviors before admission,and 77 cases didn't. (2) Compared to inpatients in group B,the rate of inpatients in group A on previous violent/aggressive behavior and the proportion on no drug administration were all higher (P<0.05). The severity of disease was higher in group A (P<0.05). The scores of CGI-SI,PANSS-EC、BARS and MOAS, and the risk of aggression and rate of anti-attack care advice were also higher in group A (P<0.05). (3) All in-patients were prescribed by the second generation antipsychotics. The ratio of risperidone was 68.9%,followed by olanzapine (13.2%) and quetiapine (5.3%). The ratios of haloperidol intramuscular injection and safeguard re-straint usage in group A were more than those in group B (P<0.05). (4) There were no significant differences on the scores of CGT-SI,MOAS,PANSS-EC,diseases severity and the days of stay in hospital between two groups (P>0.05). Conclusions The treatment efficacy of the inpatients with aggressive behaviors before admission is as same as that of inpatients without aggressive behaviors. The inpatients with aggressive behaviors have more agitation symptoms and higher risk of aggression and flee. During hospitalization,the applications of haloperidol intramuscular injection and safeguard restraint in patients with aggressive behaviors were more frequently.2014年度济宁市科技局科技医药发展规划项目4243-2471