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Zhan G.-L.,Shanghai Xuhui District Mental Health Center | Li C.-H.,Shanghai Xuhui District Mental Health Center | Zhao L.-Y.,Shanghai Xuhui District Mental Health Center | Li J.,Shanghai Xuhui District Mental Health Center | Wu Y.,Shanghai JiaoTong University
Journal of Shanghai Jiaotong University (Medical Science) | Year: 2015

Objective: To explore the effects of community mental health services on the mental health of the elderly. Methods: Four resident committees of Longhua Street community of Xuhui District in Shanghai were randomly selected and a total of 1 431 subjects were enrolled and finished the study according to the principle of voluntary and informed consent. Subjects were randomly divided into the observation group (n=692) and control group (n=739). The observation group received a series of community mental health services. Subjects were evaluated by the patient health questionnaire-9 (PHQ-9), generalized anxiety disorder screening scale-7 (GAD-7), and general well-being schedule (GWB) at baseline and by the end of 6 months and 12 months. Results: (1)Intra-group comparison of the GWB scores indicated that for the observation group, the differences of scores of worries about health, vigor, satisfaction of and interest in life, doldrums or pleasant mood, and relaxation and tension (anxiety) were statistically significant (P=0.00), except the control of the emotions and behavior (F=0.32, P=0.63). For the control group, the differences of scores of worries about health (F=4.33, P=0.02) and relaxation and tension (anxiety) (F=154.26, P=0.00) were statistically significant. (2)Inter-group comparison of the GWB scores indicated that by the end of 6 months, scores of worries about health and doldrums or pleasant mood of the observation group were remarkably better than those of the control group and the differences were statistically significant (P<0.01). By the end of 12 months, scores of satisfaction of and interest in life, worries about health, doldrums or pleasant mood, and relaxation and tension (anxiety) of the observation group were remarkably better than those of the control group and the differences were statistically significant (P<0.01). (3)For the observation group, the total score of PHQ-9 (F=1 603.27) and total score of GAD-7 (F=653.68) at baseline and by the end of 6 and 12 months decreased, while the total score of GWB (F=2 158.86) increased. The differences before and after intervention were statistically significant (P<0.01). The differences of the control group were not statistically significant (F=0.42, P=0.57; F=1.29, P=0.28; F=3.69, P=0.06). (4)The differences of scores of PHQ-9, GAD-7, and GWB at baseline between two groups were not statistically significant (P>0.05), while the differences of scores by the end of 6 and 12 months between two groups were statistically significant (P<0.01). Conclusion: The implementation of community mental health services can improve the mental health status of the elderly and the effect of persistent implementation will be more remarkable. ©, 2015, Editorial Department of Journal of Shanghai Second Medical University. All right reserved. Source


Zhang H.,Shanghai Xuhui District Mental Health Center | Li C.,Shanghai Xuhui District Mental Health Center | Zhao L.,Shanghai Xuhui District Mental Health Center | Zhan G.,Shanghai Xuhui District Mental Health Center
Shanghai Archives of Psychiatry | Year: 2015

Background: Current treatments for schizophrenia are often only partially effective. Aim: Assess the possible benefit of using adjunctive Naikan therapy, a cognitive approach based on selfreflection that originated in Japan for the treatment of schizophrenia. Methods: After resolution of acute psychotic symptoms, 235 psychiatric inpatients with schizophrenia who had a middle school education or higher were randomly assigned to a control group (n=112) that received routine medication and inpatient rehabilitative treatment or an intervention group (n=123) that also received adjunctive Naikan therapy for 2 hours daily, 5 days a week for 4 weeks. The patients were then discharged and followed up for 12 months. The Positive and Negative Syndrome Scale (PANSS), Personal and Social Performance scale (PSP), and Insight and Attitude Questionnaire (ITAQ) were used to assess patients at enrollment, after the 1-month intervention, and after the 12-month follow-up. Evaluators were blind to the group assignment of patients. Results: Only 13 (10.6%) of the intervention group participants relapsed over the 12-month follow-up, but 23 (20.5%) control group participants relapsed (X2=4.50, p=0.034). Using a modified intention-to-treat analysis and a repeated measure analysis of variance, the PANSS, PSP, and ITAQ total scores all showed significantly greater improvement over the 12-month follow-up in the Naikan group than in the control group. The drop in mean chlorpromazine-equivalent dosage from enrollment to the end of follow-up was significantly different in the intervention group but not in the control group, though the change in dosage over time between groups was not statistically significant. Conclusions: This study provides robust support for the effectiveness of Naikan therapy as an adjunctive treatment during the recovery period of schizophrenia. Compared to treatment as usually, adjunctive Naikan therapy can sustain the improvement in psychotic symptoms achieved during acute treatment, improve insight about the illness, enhance social functioning, and reduce relapse over a one-year follow-up period. Further research of this treatment with larger and more diverse samples of patients with schizophrenia is merited. © 2015, Editorial Department of the Shanghai Archives of Psychiatry. All right reserved. Source


Li C.,Shanghai Xuhui District Mental Health Center | Zhan G.,Shanghai Xuhui District Mental Health Center | Rao S.,Shanghai Xuhui District Mental Health Center | Zhang H.,Shanghai Xuhui District Mental Health Center
Journal of Nervous and Mental Disease | Year: 2014

The aim of this study was to investigate the characteristics of cognitive function damage in chronic schizophrenia patients with metabolic syndrome (MS); 388 patients were divided into two groups: MS group (180 people with schizophrenia and MS) and non-MS group (208 people with schizophrenia but without MS). The Positive and Negative Syndrome Scale (PANSS) and the Treatment Emergent Symptom Scale (TESS) were used to evaluate clinical symptoms and drug adverse reaction. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was used to assess cognitive function. There was no significant change in PANSS (p = 0.53) and TESS score (p = 0.26) between the MS group and the non-MS group. However, RBANS total scale score as well as attention, immediate memory, and delayed memory scores in the MS group were significantly lower than those in the non-MS group (p < 0.05). There was no significant change in visuospatial skill (p = 0.07) and language scores (p = 0.08) between the two groups. Besides, course of disease, triglyceride, antipsychotic drug type, systolic pressure, negative symptom factor, and education level showed a notable significance for cognitive function damage in turn. MS might aggravate injury of cognitive function in chronic schizophrenia, especially in immediate memory, delayed memory, and attention. © 2014 by Lippincott Williams & Wilkins. Source


Li C.-H.,Shanghai Xuhui District Mental Health Center | Shi L.,Shanghai Xuhui District Mental Health Center | Zhan G.-L.,Shanghai Xuhui District Mental Health Center | Rao S.-Z.,Shanghai Xuhui District Mental Health Center | Zhang H.,Shanghai Xuhui District Mental Health Center
European Review for Medical and Pharmacological Sciences | Year: 2013

Background: The risks of antipsychotic drugs on metabolic syndrome (MS) present many challenges for psychiatrists. AIM: To evaluate the effectiveness and influences on glucolipid metabolism in patients with schizophrenia and metabolic disorders switched from clozapine to ziprasidone. PATIENTS AND METHODS: Schizophrenic patients with metabolic syndrome who had been treated with clozapine for .. 2 years were enrolled in the open-label study. All the patients were switched to ziprasidone from clozapine and followed up for 24-week. The primary endpoints included body mass index (BMI), fasting glucose (FG), triglycerides (TG), HDL cholesterol (HDL-c) and systolic pressure (SP)/diastolic pressure (DP). Secondary endpoints included scores on the Positive and Negative Syndrome Scale (PANSS) and treatment emergent symptom scale (TESS). Results: A total of 213 cases satisfied the inclusion and exclusion criteria, but only 194 cases eventually completed the 24-week follow-up and were divided into ziprasidone group (n=68, complete substitution) and combined treatment group (n=126, partial substitution). In the ziprasidone group, TG at 4th and 24th week, BMI and HDL-c at 24th week were significantly improved (p < 0.05), while cognitive scores and total score of the PANSS at 4th and 24th week, negative factor, the factor of anxiety and depression at 24th week were significantly lower than those at the baseline (p < 0.05); In the combined group, cognitive factor scores (4 weekend, 24 weekends) and total score of PANSS (24 weeks) was significantly lower than baseline (p < 0.05). There was no significant difference in the TESS score (p > 0.05). Conclusions: Ziprasidone completely or partially substituting clozapine can improve both glucolipid metabolism disorders, and cognitive disorders and affective disorders of schizophrenia. Source

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