Journal List > Korean J Schizophr Res > v.18(2) > 1057817

TOOLS
Kal, Kim, Cho, Kim, Lee, Bae, and Kim: Factors Affecting Recurrence in Patients with Schizophrenia Received More Than 10 Years of Treatment
Original Article

Korean J Schizophr Res 2015;18(2):66-72.

Published online: 17 January 2015

DOI: https://doi.org/10.16946/kjsr.2015.18.2.66

Factors Affecting Recurrence in Patients with Schizophrenia Received More Than 10 Years of Treatment

Min-Jae Kal, MD, Won-Hyoung Kim, MD, Jin-Woo Cho, MD, Ji-Hyun Kim, MD, PhD, Jeong-Seop Lee, MD, PhD, Jae-Nam Bae, MD, PhD, Chul-Eung Kim, MD, PhD

1Department of Psychiatry, College of Medicine, Inha University, Incheon, Korea

Address for correspondence: Chul-Eung Kim, Department of Psychiatry, College of Medicine, Inha University, 27 Inhang-ro, Jung-gu, Incheon 22332, Korea Tel: 032-890-3475, Fax: 032-890-3558 E-mail: kce320@inha.ac.kr

      Revised 27 June 201527 July 2015       Accepted 8 September 2015

Copyright © 2015 Korean Society for Schizophrenia Research

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

The purpose of this study is to investigate the factors affecting recurrence in patients with schizophrenia received more than 10 years of longterm treatment.

Methods

The medical records of longterm followup patients with the diagnosis of schizophrenia from department of psychiatry, Inha university hospital for more than 10 years were reviewed. The recurrence was defined as the re-emergence or aggravation of psychotic symptoms after maintenance treatment during 6 months.

Results

Of the 110 patients who were included in the study, 78 patients were recurred. Half of the patients were experiencing at least 1 recurrence within six years. After adjustment of sociodemographic variables, female, poor drug compliance, younger baseline age, shorter duration of illness and longer duration of hospitalization at first admission were significantly related to an increased likelihood of recurrence. The most common stressor of recurrence was irregular drug taking (61.73%).

Conclusion

The results show the importance of gender, drug compliance, baseline age, duration of illness, and duration of hospitalization at first admission in predicting recurrence of longterm followup patients with schizophrenia.

Keywords: Schizophrenia, Recurrence, Long-Term treatment

REFERENCES

1). Gelder M, Andreasen N, López-Ibor J, Geddes J. New Oxford Text-book of Psychiatry. Oxford: Oxford University Press;2000.
2). Pigott TA, Carson WH, Saha AR, Torbeyns AF, Stock EG, Ingeni-to GG. Aripiprazole for the prevention of relapse in stabilized patients with chronic schizophrenia: a placebo-controlled 26-week study. J Clin Psychiatry. 2003; 64:1048–1056.
3). Almond S, Knapp M, Francois C, Toumi M, Brugha T. Relapse in schizophrenia: cost, clinical outcomes and quality of life. BJP. 2004; 184:346–351.
4). Knapp M, Mangalore R, Simon J. The global cost of schizophrenia. Schizophr Bull. 2004; 30:279–293.
5). Doering S, Müller E, Köpcke W, Pietzcker A, Gaebel W, Linden W, et al. Predictors of relapse and rehospitalization in schizophrenia and schizoaffective disorder. Schizophr Bull. 1998; 24(1):87–98.
crossref
6). Goodpastor WA, Hare BK. Factors associated with multiple readmissions to an urban public psychiatric hospital. Hosp Community Psychiatry. 1991; 42:85–87.
crossref
7). Lin CH, Chen WL, Lin CM, Lee MD, Ko MC, Li CY. Predictors of psychiatric readmissions in the short- and longterm: a population-based study in taiwan. Clinics (Sao Paulo). 2010; 65:481–489.
crossref
8). Kane JM. Pharmacologic treatment of schizophrenia. Biol Psychiatry. 1999; 46:1396–1408.
crossref
9). Gilbert PL, Harris MJ, McAdams LA, Jeste DV. Neuroleptic with-drawal in schizophrenic patients: a review of the literature. Arch Gen Psychiatry. 1995; 52:173–188.
10). Gitlin M, Nuechterlein K, Subotnik KL, Ventura J, Mintz J, Fogel-son DL, et al. Clinical outcome following neuroleptic discontinu-ation in patients with remitted recent-onset schizophrenia. Am J Psychiatry. 2001; 158:1835–1842.
crossref
11). Ayuso-Gutiérrez JL, del Río Vega JM. Factors influencing relapse in the longterm course of schizophrenia. Schizophr Res. 1997; 28:199–206.
crossref
12). Gaebel W. Towards the improvement of compliance: the significance of psychoeducation and new antipsychotic drugs. Int Clin Psychopharmacol. 1997; 12(Suppl 1):S37–42.
13). Hudson TJ, Owen RR, Thrush CR, Han X, Pyne JM, Thapa P, et al. A pilot study of barriers to medication adherence in schizophrenia. J Clin Psychiatry. 2004; 65:211–216.
crossref
14). Valenstein M, Blow FC, Copeland LA, McCarthy JF, Zeber LE, Gillon L, et al. Poor antipsychotic adherence among patients with schizophrenia: medication and patient factors. Schizophr Bull. 2004; 30:255–264.
crossref
15). Lacro JP, Dunn LB, Dolder CR, Leckband SG, Jeste DV. Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: a comprehensive review of recent literature. J Clin Psychiatry. 2002; 63:892–909.

Fig. 1.
Kaplan-Meier Survival plot for time to recurrence.
kjsr-18-66f1.tif
Fig. 2.
Recurrence-related stress factors.
kjsr-18-66f2.tif
Table 1.
Sociodemographic and clinical characteristics of the subjects
Total No recurrence Recurrence χ2 p-value
N (%) N (%)
Whole Sample 110 32 (29.1) 78 (70.9)
Gender
 Male 53 19 (59.4) 34 (43.6) 2.265 0.132
 Female 57 13 (40.6) 44 (56.4)
Education
 0-12 66 16 (64.0) 50 (66.7) 0.059 0.807
 ＞12 34 09 (36.0) 25 (33.3)
Married
 No 79 23 (74.2) 56 (71.8) 0.064 0.800
 Yes 30 08 (25.8) 22(28.2)
Job
 No 55 17 (53.1) 38 (48.7) 0.176 0.675
 Yes∗ 55 15 (46.9) 40 (51.3)
Economic status
 High 36 08 (25.8) 28 (35.9) 1.021 0.312
 Low 73 23 (74.2) 50 (64.1)
Inpatient or outpatient on baseline
 Outpatient 49 17 (53.1) 32 (41.0) 1.345 0.246
 Inpatient 61 15 (46.9) 46 (59.0)
Drug compliance
 Poor 57 07 (21.9) 50 (64.1) 16.206 ＜0.001
 Good 53 25 (78.1) 28 (35.9)
Comorbid
 No 103 29 (90.6) 74 (94.9) 0.687 0.407
 Yes 7 03 (9.4) 04 (5.1)

∗ : full-time, part-time, homemaker, student

Table 2.
Comparison between no recurred schizophrenia and recurred schizophrenia
No recurrence Recurrence t p
Mean (SD) Mean (SD)
Age of onset 27.94 (11.62) 25.30 (7.24) 1.175 0.247
Age (year)∗ 35.97 (11.89) 30.40 (8.75) 2.397 0.021
Duration of illness (year)∗ 08.30 (7.83) 05.00 (6.18) 2.318 0.022
Alcohol history∗ 00.73 (2.10) 03.99 (24.49) -0.438 0.663
Smoking history∗ 00.86 (1.32) 01.61 (7.30) 1.088 0.724
Body mass index (BMI)∗ 23.83 (7.64) 23.60 (4.27) 0.140 0.889
Global Assessment of Functioning (GAF)∗ 43.44 (15.89) 34.88 (15.59) 2.599 0.011
Duration of hospitalization at first admission 15.81 (21.25) 38.81 (30.99) -3.839 ＜0.001

∗ : variables assessed at initial clinic visit

Table 3.
Distribution of recurrence frequencies
Number of recurrence Number of subject (N) Percent (%)
0 32 29.1
1 34 30.9
2 24 21.8
3 13 11.8
4 06 05.5
7 01 00.9
Table 4.
Relationships between recurrence and sociodemographic and clinical characteristics
Adjusted odd ratio∗ 95% CI p
Gender
 Male 1.0
 Female 4.19 01.29-13.64 0.017
 Age of onset 1.03 0.94-1.11 0.533
Education
 0-12 1.0
 > 12 1.07 0.38-2.99 0.905
Married
 No 1.0
 Yes 0.43 0.09-1.94 0.270
Economic status
 Low 1.0
 high 0.47 0.15-1.49 0.198
Inpatient or outpatient on baseline
 Outpatient 1.0
 Inpatient 0.77 0.27-2.20 0.629
Drug compliance
 Good 1.0
 Poor 9.05 02.55-32.16 0.001
 Baseline age 0.89 0.82-0.97 0.006
 Duration of illness (year) 0.90 0.83-0.98 0.010
 Alcohol history 1.00 0.91-1.10 0.976
 Smoking history 1.42 0.71-2.85 0.323
 BMI 1.10 0.92-1.30 0.299
 Baseline GAF 0.99 0.96-1.02 0.543
 Duration of hospitalization at first admission 1.04 1.01-1.07 0.011

∗ : The Odds ratio was adjusted gender, age of onset, education, marital status, and economic status

TOOLS
Similar articles