Predictors of relapse in Chinese schizophrenia patients: a prospective, multi-center study.

OBJECTIVE: Relapse prevention is the main goal of maintenance treatment in schizophrenia. This study aimed to determine the rate and the socio-demographic and clinical predictors of relapse in Chinese schizophrenia patients following treatment of the acute phase of the illness. METHODS: In a multi-center, randomized, controlled, longitudinal study, 404 patients with schizophrenia who were clinically stabilized following an acute episode were randomly assigned to either the maintenance (i.e., initial optimal therapeutic doses continued throughout the study) or the dose-reduction group (i.e., initial optimal therapeutic doses continued for 4 or 26 weeks followed by a 50% dose reduction that was maintained until the end of the study). Participants were interviewed at entry using standardized assessment instruments, and followed up for 12-26 months. RESULTS: In univariate analyses, relapse was significantly associated with the membership of the dose-reduction group, poor medication adherence, and having a diagnosis of the paranoid type of schizophrenia. In Cox proportional-hazards regression analysis the membership of the dose-reduction group, poorer medication adherence, more severe drug-induced side effects and prominent paranoid symptoms independently predicted a higher risk of relapse. CONCLUSION: The study confirmed the importance of maintenance medication in preventing relapse in Chinese schizophrenia patients underscoring the risk of relapse associated with lack of treatment adherence, severe side effects and the patients' paranoid attitude. Socio-demographic characteristics were not associated with relapse in Chinese schizophrenia patients. Potential residual confounding caused by unmeasured variables should be fully considered in future studies.

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.

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.

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.

Prevalence and correlates of insomnia and its impact on quality of life in Chinese schizophrenia patients.

STUDY OBJECTIVES: This study aimed to determine the prevalence and the sociodemographic and clinical correlates of insomnia in Chinese schizophrenia outpatients and its impact on patients' quality of life (QOL). DESIGN: Two hundred fifty-five clinically stable schizophrenia outpatients were randomly selected in Hong Kong and their counterparts matched according to sex, age, age at onset, and length of illness were recruited in Beijing, China. All subjects at both sites were interviewed by the same investigator using standardized assessment instruments. SETTING: Hong Kong and Beijing, China. PATIENTS OR PARTICIPANTS: Clinically stable schizophrenia outpatients. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: In the combined Beijing-Hong Kong sample the frequency of at least one type of insomnia over the previous 12 months was 36.0%; the rates of difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and early morning awakening (EMA) were 21.2%, 23.6%, and 11.9%, respectively. Poor sleep was significantly associated with advanced age, older age at onset, fewer psychiatric admissions, severity of positive symptoms, anxiety, extrapyramidal symptoms (EPS) and depressive symptoms, less frequent use of atypical antipsychotic medications (AP), and more frequent use of benzodiazepines (BZD) and hypnotics. Poor sleepers had significantly poorer QOL in all domains than patients without insomnia. After controlling for the potential confounding effects of sociodemographic and clinical factors, a significant difference remained between the 2 groups with regard to the physical QOL domain. A multiple logistic regression analysis found that advanced age, fewer psychiatric admissions, severity of depressive symptoms and use of hypnotics were significant contributors to poor sleep. CONCLUSION: Insomnia is independently associated with poor QOL. More attention should be paid in clinical practice to the high rate of insomnia in Chinese schizophrenia patients.

Socio-demographic and clinical correlates of lifetime suicide attempts and their impact on quality of life in Chinese schizophrenia patients.

This study determines the socio-demographic and clinical correlates of suicide attempts in Chinese schizophrenia outpatients and their impact on patients' quality of life (QOL). Two hundred and fifty-five clinically stable schizophrenia outpatients were randomly selected in Hong Kong (HK) and their counterparts matched according to sex, age, age at onset and length of illness were recruited in Beijing (BJ). All subjects at both sites were interviewed by the same investigator using standardized assessment instruments. Basic socio-demographic and clinical data and history of suicide attempts were collected. The lifetime prevalence of suicide attempts was 26.7% in the whole sample and 20% and 33.6% in the HK and BJ samples, respectively. Patients with a history of suicide attempts were less likely to receive depot antipsychotic (AP) medication, more likely to receive clozapine, benzodiazepines (BZD) and higher doses of APs; were younger at onset, had more hospitalizations; had more severe positive, depressive, anxiety and extrapyramidal (EPS) symptoms; were poorer QOL in the physical, psychological, social and environmental domains; and were more likely to be BJ residents. In multiple logistic regression analysis, early age at onset, poor physical QOL, use of clozapine and BZDs, and study site (HK vs BJ) were significant contributors to lifetime suicide attempts. Significant difference was found between matched samples in HK and BJ with respect to suicide attempts. HK is a cosmopolitan city with a Western social structure and mental health system, whereas in BJ more traditional Chinese cultural values predominate, with a mental health policy radically different from that of HK. These differences suggest that socio-cultural factors play a significant role in determining suicide attempts in schizophrenia.

Plasma S-100B protein in Chinese patients with schizophrenia: comparison with healthy controls and effect of antipsychotics treatment.

PURPOSE: To examine the possibility that structural damage to the brain may play a role in the pathogenesis of schizophrenia by measuring the level of plasma S-100B, a calcium-binding protein found predominantly in the cytosol of glial cells. METHOD: Fifty-seven Chinese psychiatric inpatients who met DSM-IV diagnosis of schizophrenia and 60 healthy controls were enrolled in the study. Patients were assessed with the Positive and Negative Symptoms Scale (PANSS) at admission and at 12 weeks after treatment. Plasma samples were collected from patients and controls and S-100B protein was assayed using ELISA. RESULTS: (1) 29 of 57 patients (50.9%) showed increased S-100B level compared to the mean level of 60 healthy controls (p<0.005) vs. only 1 of 60 (1.67%) controls. The S-100B levels of unmedicated (0.119+/-0.059microg/L) and medicated patients (0.117+/-.0.057microg/L) were significantly higher than controls (0.067+/-0.022microg/L, both p<0.001), and S-100B levels of unmedicated patients were higher than those of medicated patients (p=0.024); (2) at admission, S-100B level was positively correlated with total score of PANSS (r=0.269, p=0.043), especially with negative subscore of PANSS (r=0.306, p=0.021), but the correlation was no longer present after patients were treated by anti-psychotic agents. CONCLUSION: The S-100B levels of patients with schizophrenia are significantly higher than that of healthy controls, and the S-100B level is associated with severity of psychopathology, particularly negative symptoms, indicating that patients with schizophrenia may suffer structural damage to central nervous system. The concentration of S-100B may also be associated with treatment progress.

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.

Serum concentrations of clozapine and norclozapine in the prediction of relapse of patients with schizophrenia.

Schizophrenic outpatients (n=102) whose condition had stabilized with clozapine (CLZ) therapy and were being maintained on CLZ were followed for 1 year. Clinical status and concentrations of serum clozapine (CLZ) and its metabolite norclozapine (NCLZ) were evaluated periodically or when relapse occurred. Relapse was defined as a significant exacerbation of psychotic symptoms or hospitalization. Thirty-three patients relapsed and 69 did not. Relapse patients displayed significantly lower serum concentrations of CLZ and a sum of CLZ and NCLZ at endpoint than non-relapses (CLZ: 162 ng/ml vs. 237 ng/ml, p<0.001; CLZ+NCLZ: 225 ng/ml vs. 301 ng/ml, p<0.001). When all subjects were pooled together, a significant inverse correlation was observed between percent increase in the total score on the Brief Psychiatric Rating Scale (BPRS) from baseline and serum levels of CLZ alone (r=0.404, p<0.001) and the sum of CLZ and NCLZ (r=0.364, p<0.001). Relapses and non-relapses were well separated by a threshold CLZ serum concentration of 200 ng/ml with a sensitivity of 73% and a specificity of 80%. The threshold value represented about a 40% lower serum CLZ level than concentration achieved in acute treatment. Survival analysis showed a similarity of the relapse risk over time defined by the CLZ serum threshold and by symptomatic criteria. These results suggest that effective relapse prevention may require maintenance of patients at CLZ serum concentrations above 200 ng/ml and above 60% of the acute-phase level during long-term maintenance treatment of schizophrenia.

The differential effects of steady-state fluvoxamine on the pharmacokinetics of olanzapine and clozapine in healthy volunteers.

The combination of atypical antipsychotics and selective serotonin reuptake inhibitors is an effective strategy in the treatment of certain psychiatric disorders. However, pharmacokinetic interactions between the two classes of drugs remain to be explored. The present study was designed to determine whether there were different effects of steady-state fluvoxamine on the pharmacokinetics of a single dose of olanzapine and clozapine in healthy male volunteers. One single dose of 10 mg olanzapine (n = 12) or clozapine (n = 9) was administered orally. Following a drug washout of at least 4 weeks, all subjects received fluvoxamine (100 mg/day) for 9 days, and one single dose of 10 mg olanzapine or clozapine was added on day 4. Plasma concentrations of olanzapine, clozapine, and N-desmethylclozapine were assayed at serial time points after the antipsychotics were given alone and when added to fluvoxamine. No bioequivalence was found in olanzapine alone and cotreatment with fluvoxamine for the mean peak plasma concentration (C(max)), the area under the concentration-time curve from time 0 to last sampling time point (AUC(0-t)), and from time 0 to infinity (AUC(0- infinity )). Under the cotreatment, C(max) of olanzapine was significantly elevated by 49%, with a 32% reduced time (t(max)) to C(max), whereas the C(max) and t(max) of clozapine were unaltered. The cotreatment increased the AUC(0-t) and AUC(0- infinity ) of olanzapine by 68% and 76%, respectively, greater than those of clozapine (40% and 41%). The presence of fluvoxamine also prolonged the elimination half-life (t(1/2)) of olanzapine by 40% and, to a much greater extent, clozapine by 370% but reduced the total body clearance (CL/F) of clozapine (78%) more significantly than it did for olanzapine (42%). The apparent volume of distribution (V(d)) was suppressed by 31% in olanzapine combined with fluvoxamine but was unaltered in the clozapine regimen. A significant reduction in the N-desmethylclozapine to clozapine ratio was present in the clozapine with fluvoxamine regimen. The effects of fluvoxamine on different aspects of pharmacokinetics of the two antipsychotics may have implications for clinical therapeutics.

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.

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.

Long-term use of mood stabilizers and its impact on the quality of life of chinese patients with schizophrenia.

OBJECTIVES: To date, no studies have investigated the prescription patterns of mood stabilizers (MSs) in Chinese patients with schizophrenia. This study examined the frequency and sociodemographic and clinical correlates of MS prescription for outpatients with schizophrenia in Hong Kong (HK) and Beijing (BJ), China. METHODS: Five hundred five clinically stable outpatients with schizophrenia were randomly selected and interviewed in HK and BJ using standardized assessment instruments. Basic sociodemographic and clinical data and psychotropic drug prescriptions were collected at the time of a diagnostic interview. RESULTS: Thirty-four (6.7%) of the patients were prescribed MSs in the whole sample, with 10.2% and 3.2% of the HK and BJ samples, respectively. Use of MSs was associated with a history of violence, number of admissions, and severity of extrapyramidal side effects. In multiple logistic regression analysis, number of admissions, study site, sex, and length of illness were significantly associated with MSs. CONCLUSIONS: Although the ethnic and clinical characteristics of the 2 samples were nearly identical, there was a wide variation in the frequency of MS prescriptions between HK and BJ.

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

PURPOSE: This 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 METHODS: Two 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. RESULTS: There 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. CONCLUSION: Despite 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.

Clinical correlates of clozapine prescription for schizophrenia in China.

AIMS: Few studies have investigated the prescription patterns of clozapine in outpatients with schizophrenia in China. It is an important issue due to clozapine's high efficacy and potentially fatal side effect profile. This study examined the use of clozapine and its correlates in China. METHODS: Three hundred ninety-eight clinically stable outpatients with schizophrenia were randomly selected and interviewed in Hong Kong (HK) and Beijing (BJ). Assessment instruments included the Structured Clinical Interview for DSM-IV, Brief Psychiatric Rating Scale, Simpson and Angus Scale of Extrapyramidal Symptoms, Barnes Akathisia Rating Scale and the Hong Kong and Mainland China World Health Organization Quality of Life Schedule-Brief version. Assessments were performed by the same investigator in both sites. RESULTS: Clozapine was prescribed to 15.6% of (n = 62) patients. There was a wide inter-site variation between HK and BJ. Use of clozapine was associated with age, age at onset, extrapyramidal side effects (EPS), having health insurance, use of depot and typical antipsychotic and anticholinergic drugs and benzodiazepines as well as history of suicidal attempts. On multiple logistic regression analysis, the number of hospitalizations, site (HK vs. BJ), use of typical antipsychotics, polypharmacy and co-prescription with anticholinergics were significantly associated with the prescription of clozapine. No significant differences were found between the clozapine and non-clozapine groups with regard to any of the quality of life domains. CONCLUSION: A combination of economical and clinical factors, health policies and the characteristics of the treatment settings plays important roles in determining clozapine use. Clozapine appears to have little significant influence on quality of life in clinical stable Chinese patients with schizophrenia.

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.

Exploring the clinical and social determinants of prescribing anticholinergic medication for Chinese patients with schizophrenia.

AIMS: To-date few studies have investigated prescription patterns of anticholinergic medication (ACM) in Chinese patients with schizophrenia in general and outpatients in particular. This study examined the frequency and socio-demographic and clinical correlates of ACM in Hong Kong (HK) and Beijing (BJ), China. METHODS: Five hundred and five clinically stable outpatients with schizophrenia were randomly selected and interviewed in HK and BJ using standardized assessment instruments. Basic socio-demographic and clinical data and psychotropic drug prescriptions were collected at the time of the diagnostic interview. RESULTS: ACM was found in 47.7% of (n = 241) the whole sample and in 54.1 and 41.2% of the HK and BJ samples, respectively. ACM was associated with more frequent use of antipsychotic (AP) polypharmacy, typical AP drugs, and a combination of depot and oral AP, less use of clozapine and atypical and oral AP, a lack of health insurance, higher doses of APs, severity of extrapyramidal side effects (EPS), a higher number of APs prescribed, and study sites. In multiple logistic regression analysis, higher doses of APs, less frequent use of an atypical AP, and study sites all remained significantly associated with ACM. CONCLUSION: Although the ethnic and clinical characteristics of the two samples were nearly identical, there was a wide variation in the frequency of ACM prescriptions between HK and BJ suggesting that socio-cultural and economical factors as well as traditions of psychiatric practice all played a role in determining the use of ACM. Prescribing ACM in neither site was in line with current recommendation.

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.

Efficacy of the Community Re-Entry Module for patients with schizophrenia in Beijing, China: outcome at 2-year follow-up.

BACKGROUND: Few psychosocial interventions have been developed in China that are suitable for use in the community. AIMS: To evaluate the effectiveness of the Chinese version of the Community Re-Entry Module (CRM; a module of a standardised, structured social skills training programme devised at the University of California, Los Angeles) for patients with schizophrenia compared with standard group psychoeducation. METHOD: Patients with schizophrenia (n=103) were randomly allocated to CRM or psychoeducation groups and followed up for 24 months. Outcome measures included social functioning, psychiatric symptoms, insight, re-employment, relapse and re-hospitalisation rates. RESULTS: The CRM group significantly improved in terms of social functioning, insight and psychiatric symptoms compared with the psychoeducation group; the re-employment rate was significantly higher and relapse and rehospitalisation rates were significantly lower in the CRM group. CONCLUSIONS: The findings support the feasibility and effectiveness of CRM as a psychosocial intervention for Chinese patients with schizophrenia in the community.