| Background: Patients with schizophrenia face a high risk of relapse and suicide,and are prone to accidents and violent behaviors,which bring serious burdens to families and society.Relapse is the biggest problem to be solved in schizophrenia.Expert consensus recommends the use of long-acting injections to reduce the relapse rate of patients.However,in previous studies in China,long-acting injections were mainly used for inpatients or outpatients,and there were few community patients and long-term observation studies.Therefore,this study explored the efficacy of long-acting injections for community home patients.Objective: The purpose of this study was to investigate the efficacy,recurrence rate,safety and social function improvement of paliperidone palmitate injection in community schizophrenia patients.At the same time,the difference in curative effect of patients with regular oral second-generation antipsychotic drugs in the community was compared.It provides a reference for the community management of home patients in the future.Methods:Among the patients with schizophrenia under the management of community archives in a certain place in Shandong,130 patients were selected as the research objects according to the inclusion and exclusion criteria.After numbering,they were divided into the study group（injected paliperidone palmitate,65 cases）and the control group（regular oral antipsychotic drugs,65 cases）by random number table method.Positive and Negative Syndrome Scale（PANSS）,Personal and Social Performance（PSP）and The Clinical Global Impression Scale（CGI-S）and Treatment Emergent Symptom Scale（TESS）were used for evaluation,and the recurrence rate and readmission rate of the two groups were analyzed,using SPSS 26.0 statistical software before treatment and at 1、3、6、9、and 12 months after the treatment.Results:1.Five patients dropped out in each group,and sixty patients completed the study in each group.There was no significant difference in PANSS total score,PSP total score,CGI-S total score,age,course of disease and gender between the two groups before treatment（all P>0.05）.2.PANSS total score: The PANSS total score of the two groups was significantly lower than that before treatment at 3、6、9、and 12 months after the treatment.The study group was significantly lower than the control group at 3、6、9and 12 months after the treatment.The differences were statistically significant（all P<0.05）.3.The total score of the positive symptom scale in PANSS: The total score of the PANSS positive scale in the two groups was significantly lower than that before treatment at 1、3、6、9and 12 months after the treatment.The study group was significantly lower than the control group at 3、6、9and 12 months after the treatment.The difference was statistically significant（all P<0.05）.Negative symptom scale total score: The total score of PANSS negative symptom scale in the two groups was significantly lower than that before treatment at 3、6、9and 12 months after the treatment,and the study group was significantly lower than the control group,and the differences were statistically significant（all P<0.05）.General pathological symptom scale total score: The total score of PANSS general pathological symptom scale in the two groups was significantly lower than that before treatment at 3、6、9and 12 months after the treatment,and the differences were statistically significant（all P<0.05）,there was no significant difference between the study group and the control group at1、3、6、9and 12 months after the treatment（all P>0.05）.4.In the 12-month study,12 patients recurred in the study group,with a recurrence rate of 20.00%（12/60）,and 26 patients recurrences in the control group,with a recurrence rate of 43.30%（26/60）.The comparison of chi square test between the two groups showed statistical significance（P<0.05）.In terms of the number of recurrences,10 patients had one recurrence,2 patients had two recurrences in the study group;17patients had one recurrence,8 patients had two or more recurrences in the control group.5.PSP total score: The total PSP score of the two groups was significantly higher than that before treatment at 1、3、6、9and 12 months after the treatment,and the study group was significantly higher than the control group at 3、6、9and 12 months after the treatment.The differences were statistically significant（all P<0.05）.6.PSP scores:（a beneficial activities in society,b personal and social relationships,c self-care,d aggressive behavior）four total scores compared with those before treatment significantly decreased at 1、3、6、9 and 12 months after the treatment,and the difference was statistically significant（all P<0.05）.In item a,the scores of the study group were significantly lower than those of the control group at 1、3、6、9 and 12 months after the treatment;in item b,the scores of the study group were significantly lower than the control group at 3、6、9 and 12 months after the treatment;in item c and item d,the scores of the study group were significantly lower than those of the control group at 1、3 months after the treatment,and the differences were statistically significant（all P<0.05）.7.CGI-S total score: The CGI-S total score in the two groups was significantly lower than that before treatment at 1、3、6、9 and 12 months after the treatment,the study group significantly lower than the control group,and the differences were statistically significant（all P<0.05）.8.Rehospitalization rate: Eight patients were rehospitalized in the study group,the re-hospitalization rate was 13.33%（8/60）,and 23 patients were rehospitalized in the control group,and the re-hospitalization rate was 38.33%（23/60）.The comparison results of chi square test between the two groups showed statistical significance（all P<0.05）.9.Safety: 23 patients had adverse reactions in the study group,and the incidence of adverse reactions was 38.33%（23/60）,while 32 patients had adverse reactions in the control group,and the incidence of adverse reactions was 53.33%（32/60）.The comparison results of chi square test between the two groups showed no statistical significance（P>0.05）.10.Influencing factors of relapse: Logistic regression analysis showed that group and family relationship were the influencing factors of recurrence in community schizophrenia patients（OR=4.420,95%CI:1.708-11.438,P<0.05;OR=4.363,95%CI: 1.600-11.898,P < 0.05）.Conclusion:1.Injected paliperidone group had better improvement in positive symptoms,negative symptoms,and social functioning（socially beneficial activities and personal and social relationships）than oral antipsychotics group,but in general pathological symptoms,social functionality（self-care and disruptive and aggressive behavior）did not differ significantly between the two groups.2.The recurrence rate of injected paliperidone group was significantly lower than that of oral antipsychotics group,the number of recurrences was significantly reduced,the rate of rehospitalization was reduced,the severity of the disease was improved,and no new adverse reactions were found.Compared with injectable paliperidone,oral antipsychotics are more likely to cause relapse,poor family relationships can also cause patients to relapse.3.This study is carried out in conjunction with a health poverty alleviation pilot project.It has played a good role in demonstration and driving.At present,a larger sample of long-acting injection has been applied in a certain place in Shandong,which provides reference for later research. |
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