Clinical and social determinants of antipsychotic polypharmacy for Chinese patients with schizophrenia. The Chinese First-Episode Schizophrenia Trial: background and study design. Traditional Chinese medical treatment to invigorate blood and relieve stasis treatment of schizophrenia: comparison with antipsychotics treatment. Effectiveness of psychoeducational intervention for rural Chinese families experiencing schizophrenia
 An RCT with three-year follow-up of peer support groups for Chinese families of persons with schizophrenia. The effectiveness of psychoeducational family intervention for patients with schizophrenia in a 14-year follow-up study in a Chinese rural area. Psychoeducation Program for Chinese Family Carers of Members With Schizophrenia Effectiveness of Psychoeducation and Mutual Support Group Program for Family Caregivers of Chinese People with Schizophrenia Effects of a mutual support group for families of Chinese people with schizophrenia: 18-month follow-up. Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001–05: an epidemiological survey One-year follow-up of a multiple-family-group intervention for Chinese families of patients with schizophrenia. Family-based intervention for schizophrenic patients in China. A randomised controlled trial. Effectiveness of a mutual support group for families of patients with schizophrenia. The schizophrenia care management program for family caregivers of Chinese patients with schizophrenia. Prescribing for inpatients with schizophrenia: an international multi-center comparative study. A controlled trial of a needs-based, nurse-led psychoeducation programme for Chinese patients with first-onset mental disorders: 6 month follow up. Effect of antipsychotic medication alone vs combined with psychosocial intervention on outcomes of early-stage schizophrenia: A randomized, 1-year study.
Most prescription pattern surveys have found a high rate of  antipsychotic polypharmacy . To date few studies have investigated antipsychotic polypharmacy  in Chinese patients with schizophrenia in general and out patients in particular . This study examined the frequency and sociodemographic and clinical correlates of antipsychotic polypharmacy  in Hong Kong ( HK ) and Beijing ( BJ ) , China . Three hundred and ninety-eight clinical ly stable out patients with schizophrenia were r and omly selected and interviewed in HK and BJ using st and ardized assessment instruments .  Antipsychotic polypharmacy  was found in 17.6 % ( N=70 ) of the whole sample and in 28 % and 7.1 % of the HK and BJ sample s , respectively . Polypharmacy was associated with monthly income , severity of negative symptoms and extrapyramidal side effects ( EPS ) , use of depot antipsychotic and anticholinergic drugs , doses of antipsychotics , and the number of hospitalizations . In multiple logistic regression analysis , younger age , number of hospitalizations , site ( HK vs. BJ ) , and the use of depot antipsychotics were all significantly associated with antipsychotic polypharmacy . Although the ethnic and clinical characteristics of the two cohorts were nearly identical , there was a wide variation in the prescription frequency of antipsychotic polypharmacy between HK and BJ , suggesting that sociocultural and economical factors and traditions of psychiatric practice all played a role in determining antipsychotic polypharmacy . Clinicians should bear in mind that , at least for clinical ly stable patients , no scientifically sound therapeutic principles for antipsychotic polypharmacy exist Schizophrenia is a complex illness with unknown aetiology and pathogenesis . Currently , a considerable number of patients with schizophrenia do not receive st and ardised and systematic treatment in China . In the past years , many controlled trials have been conducted in chronic schizophrenia . In contrast , research on first-episode schizophrenia is lacking . This paper describes the background and design of the Chinese First-Episode Schizophrenia Trial project -- a multicentre , r and omised , open-label clinical trial . A total of 600 first-episode schizophrenia patients were r and omly divided into 3 groups and treated with risperidone , aripiprazole , and olanzapine for 1 year . During the study period , only 1 medication change of the 3 antipsychotic medications was allowed In this study , 80 schizophrenic patients , divided into two groups of 40 , were treated with traditional Chinese medicine to invigorate the blood and relieve stasis and antipsychotic drugs , and were observed by the rating methods of BPRS , TESS , CGI scale and hemorheology test . The results show that such traditional Chinese medicine to invigorate blood and relieve stasis has fewer side effects on schizophrenic patients than do antipsychotic drugs , and there is objective evidence of hemorheology changes . Traditional Chinese medicine is superior to antipsychotic drugs in the effects of anti-anxiety-depression and antipsychomotor inhibition , but it is less effective in controlling psychomotor excitation compared with antipsychotic drugs Abstract . Background : The aim of this study was to explore the characteristics and efficacy of psychoeducational family intervention for persons with schizophrenia in rural China . Methods : A cluster r and omised controlled trial of psychoeducational family intervention for families experiencing schizophrenia ( three groups , 326 cases ) was conducted in Xinjin County , Chengdu . Treatment groups consisted of family intervention and medication , medication alone , and a control . Results : The results showed a gain in knowledge , a change in the relatives ' caring attitudes towards the patients , and an increase in treatment compliance in the psychoeducational family intervention group ( p < 0.05 , 0.001 ) . Most importantly , the relapse rate over 9 months in this group ( 16.3 % ) was half that of the drug-only group ( 37.8 % ) , and just over one-quarter of that of the control group ( 61.5 % ) ( p < 0.05 ) . Antipsychotic drug treatment and families ' attitudes towards patients after the 9-month follow-up were significantly associated with clinical outcome ( p < 0.05 ) . Conclusions : In rural China , family intervention should focus on improving the relatives ' recognition of illness , the caring attitude towards the patients , treatment compliance , relapse prevention , and the training of the patients ' social functioning . This trial , one of the largest in the literature , has shown that psychoeducational family intervention is effective and suitable for psychiatric rehabilitation in Chinese rural communities OBJECTIVE This study was conducted to test the effects of a nine-month family-led peer support group for Chinese people with schizophrenia in Hong Kong over a three-year follow-up and to compare outcomes with those of psychoeducation and st and ard psychiatric outpatient care . METHODS A r and omized controlled trial of 106 Chinese families of patients with schizophrenia was conducted between August 2007 and January 2011 in three psychiatric outpatient clinics . Families were r and omly assigned to peer support ( N=35 ) , psychoeducation ( N=35 ) , or st and ard care ( N=36 ) . In addition to st and ard care received , peer support and psychoeducation consisted of 14 two-hour group sessions , with patients participating in six to 14 sessions . Multiple patient and family outcomes --including families ' support service utilization and functioning and patients ' functioning mental state and rehospitalization rate -- were measured at recruitment and one week , 18 months , and 36 months after completion of the interventions . RESULTS Patients and families in the peer support group reported consistently greater improvements over three years in overall functioning ( family p<.005 ; patient p<.001 ) and reductions in duration and number of hospitalizations ( p<.01 for both ) , without any increase in service utilization . CONCLUSIONS Family-led peer support groups were an effective intervention for Chinese people with schizophrenia , result ing in long-term effects of improving patient and family functioning and reducing rehospitalizations BACKGROUND It is unclear if the impact of psychoeducational family intervention for patients with schizophrenia can be sustained over 10 years . In this study , we explored the 14-year effect of psychoeducational family intervention for patients with schizophrenia in a Chinese rural area . METHOD The data from a cluster r and omized control trial ( C RCT ) study of psychoeducational family intervention in a 14-year follow-up was analyzed . All patients with schizophrenia ( n = 326 ) who participated in the C RCT drawn from six townships in Xinjin County of Chengdu in 1994 , of whom 238 ( 73.0 % ) who were still alive , and their informants were followed up in 2008 . The Patients Follow-up Scale , the Positive and Negative Syndrome Scale ( PANSS ) and the Global Assessment of Functioning were used in the follow-up study . RESULTS There were no significant differences of marital status , mean scores of PANSS positive symptoms , negative symptoms , general mental health , and total scores among the psychoeducational family intervention , medication , and control groups in 2008 . The psychoeducational family intervention group had a significantly higher rate of antipsychotic medication and a higher level of work ability than other two groups . The control group had a significantly higher rate of never-treated ( 26.0 % ) than psychoeducational family intervention group ( 6.5 % ) . CONCLUSION Psychoeducational family intervention might be still effective in the 14-year follow-up , especially in patients ' treatment adherence/compliance and social functioning .  Psychoeducational family intervention might be more effective in places where family members frequently participated in patients ' care and had a lower level of knowledge on mental illness . Family intervention should be considered when making mental health policy and planning mental health services The purpose of this study was to evaluate the effectiveness of a psychoeducation program for Chinese family carers of members with schizophrenia in Hong Kong . The participants consisted of 64 carers of clients with schizophrenia who were recruited from a local mental hospital and r and omly assigned to the experimental and control arm ( 32 each ) . The experimental group received a psychoeducation program developed and implemented by mental health nurses based on Atkinson and Coia ’s framework . The control group received routine care . The outcome measures were family burden , self-efficacy , and perception of social support . The findings showed that the experimental group had more improvement on their perception of burden of care ( t = 5.25 , p < .01 ) , self-efficacy ( t = -7.16 , p < .01 ) , and social support ( t= -5.61 , p < .01 ) . This study supports psychoeducation as an effective nursing intervention for Chinese family carers Schizophrenia is a disruptive and distressing illness , not only for the person affected but also for family members . Family intervention , particularly in a group format using a diverse range of modalities , is thought to effectively satisfy the informational needs of families and enhance their coping abilities when caring for a relative with schizophrenia , and thus reduce a patient ’s relapse from illness . This study tested the hypothesis that participants in a family psychoeducation and mutual support group would demonstrate significant improvements in levels of patient and family functioning and shorter duration of re-hospitalization than families in routine care . A r and omized controlled trial was conducted with a sample of 68 Chinese families of schizophrenia sufferers in Hong Kong , who were r and omly assigned to either a  family psychoeducation and support group  ( n = 34 ) , or a  routine care group  ( n = 34 ) . The interventions were delivered at two psychiatric outpatient clinics over a nine-month period . Results of multivariate analyses of variance test indicated that the psychoeducation and support group reported greater improvements on family and patient functioning and shorter lengths of patient hospitalizations at the two post-tests ( one month and one year after completion of the intervention ) , compared with the routine care group . The findings substantiate that within a Chinese context , psychoeducation and mutual support group intervention can effectively help families care for a mentally ill relative BACKGROUND Family intervention in schizophrenia can reduce patient relapse and improve medication adherence , but few studies on this have involved a Chinese population . AIMS To examine the effects of a mutual support group for Chinese families of people with schizophrenia , compared with psychoeducation and st and ard care . METHOD R and omised controlled trial in Hong Kong with 96 families of out- patients with schizophrenia , of whom 32 received mutual support , 33 psychoeducation and 31 st and ard care .  The psychoeducation group included patients in all the sessions , the mutual support group did not . Intervention was provided over 6 months , and patient- and family-related psychosocial outcomes were compared over an 18-month follow-up . RESULTS Mutual support consistently produced greater improvement in patient and family functioning and caregiver burden over the intervention and follow-up periods , compared with the other two conditions . The number of readmissions did not decrease significantly , but their duration did . CONCLUSIONS Mutual support for families of Chinese people with schizophrenia can substantially benefit family and patient functioning and caregiver burden BACKGROUND In China and other middle-income countries , neuropsychiatric conditions are the most important cause of ill health in men and women , but efforts to scale up mental health services have been hampered by the absence of high- quality , country-specific data for the prevalence , treatment , and associated disability of different types of mental disorders . We therefore estimated these variables from a series of epidemiological studies that were done in four provinces in China . METHODS We used multistage stratified r and om sampling methods to identify 96 urban and 267 rural primary sampling sites in four provinces of China ; the sampling frame of 113 million individuals aged 18 years or older included 12 % of the adult population in China . 63 004 individuals , identified with simple r and om selection methods at the sampling sites , were screened with an exp and ed version of the General Health Question naire and 16,577 were administered a Chinese version of the Structured Clinical Interview for Diagnostic and Statistical Manual (DSM)-IV axis I disorders by a psychiatrist . FINDINGS The adjusted 1-month prevalence of any mental disorder was 17.5 % ( 95 % CI 16.6 - 18.5 ) . The prevalence of mood disorders was 6.1 % ( 5.7 - 6.6 ) , anxiety disorders was 5.6 % ( 5.0 - 6.3 ) , substance abuse disorders was 5.9 % ( 5.3 - 6.5 ) , and psychotic disorders was 1.0 % ( 0.8 - 1.1 ) . Mood disorders and anxiety disorders were more prevalent in women than in men , and in individuals 40 years and older than in those younger than 40 years . Alcohol use disorders were 48 times more prevalent in men than in women . Rural residents were more likely to have depressive disorders and alcohol dependence than were urban residents . Among individuals with a diagnosable mental illness , 24 % were moderately or severely disabled by their illness , 8 % had ever sought professional help , and 5 % had ever seen a mental health professional . INTERPRETATION Substantial differences between our results and prevalence , disability , and treatment rate estimates used in the analysis of global burden of disease for China draw attention to the need for low-income and middle-income countries to do detailed , country-specific situation analyses before they scale up mental health services . FUNDING China Medical Board of New York , WHO , and Sh and ong Provincial Bureau of Health OBJECTIVES This study tested the effectiveness of a mutual support multiple-family-group intervention for schizophrenia in terms of improvements in patients ' psychosocial functioning , use of mental health services , and rehospitalization compared with a psychoeducation intervention and st and ard care . METHODS A controlled trial was conducted in a sample of 96 Chinese families who were caring for a relative with schizophrenia in Hong Kong . The families were r and omly assigned to one of three groups : mutual support ( N=32 ) , psychoeducation ( N=33 ) , and st and ard care ( N=31 ) . The interventions were delivered at two psychiatric outpatient clinics over a six-month period . The mutual support and psychoeducation interventions consisted of 12 group sessions every two weeks , each lasting about two hours . The mutual support group was a peer-led group design ed to provide information , emotional support , and coping skills for caregiving in stages . The psychoeducation group was a professional-led group design ed to educate families about the biological basis of schizophrenia and treatment and to improve illness management and coping skills . The st and ard care group and the other two groups received routine psychiatric outpatient care during the intervention . Data analyses of multiple outcomes over one-year follow-up were conducted on an intention-to-treat basis . RESULTS Multivariate analyses of variance showed that the mutual support intervention was associated with consistently greater improvements in patients ' functioning and rehospitalization and stable use of mental health services over the follow-up period compared with the other two interventions . CONCLUSIONS The study provides evidence that mutual support groups can be an effective family intervention for Chinese persons with mental illness in terms of improving patients ' functioning and hospitalization without increasing their use of mental health services BACKGROUND We developed and evaluated a comprehensive , ongoing intervention for families of schizophrenic patients appropriate for China 's complex family relationships and unique social environment . METHOD Sixty-three DSM-III-R schizophrenic patients living with family members were enrolled when admitted to hospital and r and omly assigned to receive st and ard care or a family-based intervention that included monthly 45-minute counselling sessions focused on the management of social and occupational problems , medication management , family education , family group meetings , and crisis intervention . RESULTS At 6 , 12 , and 18-month follow-ups by blind evaluators , the proportion of subjects rehospitalised was lower , the duration of rehospitalisation was shorter , and the duration of employment was longer in the experimental group than in the control group ; these differences were statistically significant at the 12 and 18-month follow-ups and were not explained by differences in drug compliance . Family intervention was associated with significantly lower levels of family burden . CONCLUSIONS This intervention is less costly than st and ard treatment , is suitable for urban families of schizophrenic patients in China and feasible given the constraints of the Chinese mental health system AIM This paper reports a study to examine the effectiveness of a 12-session mutual support group for Chinese families caring for a relative with schizophrenia compared with a psycho-educational group and routine family support services in Hong Kong . BACKGROUND Schizophrenia is a disruptive and distressing illness for patients and their families . With the current trend of community care for mental illness , there is evidence that family intervention reduces patient relapse and re-hospitalization , satisfies the health needs of families and enhances their coping capabilities . METHODS A r and omized controlled trial was conducted from May 2002 to June 2003 with 96 Chinese families of a relative with schizophrenia selected from two psychiatric outpatient clinics in Hong Kong . Families were r and omly assigned to receive mutual support ( n = 32 ) , psycho-education ( n = 33 ) or st and ard care only ( n = 31 ) . The interventions were delivered at outpatient clinics over a 6-month period . Pre- and post- ( 1 week and 6 months ) testing took place and families ' functioning , mental health service utilization , patients ' level of functioning and duration of re-hospitalization were measured . RESULTS At both post-test periods , family caregivers and patients in the mutual support group reported statistically significant improvements on family and patients ' level of functioning , when compared with their counterparts in the psycho-education and st and ard care groups . CONCLUSIONS The findings support the use of mutual support groups as an effective modality of family intervention in a Chinese population caring for a family member with schizophrenia to improve both family and patient functioning OBJECTIVES This study tested the effectiveness of a schizophrenia care management program for family caregivers of Chinese patients with schizophrenia in Hong Kong . METHODS A multisite controlled trial was conducted with 92 patient-caregiver dyads . They were r and omly assigned to either the schizophrenia care management program or to usual care . The patients ' symptoms , functioning , and length of rehospitalization and their families ' perceived social support , expressed emotion , and functioning were measured at recruitment and at one month and 15 months after the intervention . RESULTS Compared with families in the usual care group , families in the schizophrenia care management program reported significantly greater improvements in families ' and patients ' functioning and caregivers ' perceived social support and decreases in the number and length of patients ' rehospitalization . CONCLUSIONS The findings provide evidence that the multidisciplinary schizophrenia care program can improve the psychosocial functioning of patients and their families and social support of caregivers BACKGROUND This study compares prescription practice s for acute in patients with schizophrenia among six academic departments located in China , Japan , Hungary , and the U.S. METHODS Prescription data for a sample of 429 in patients from six academic departments were collected on a r and omly chosen census day . All patients met criteria for schizophrenia according to DSM-IV and had a length of illness of at least two years . RESULTS While patients at the different centers varied in their demographic and clinical characteristics , i. e. , age , sex , and length of illness , a great variation in prescription patterns for antipsychotic and other psychotropic drugs among centers was observed even within the same country for all the variables studied ( i. e. , number and dose antipsychotics , atypical and depot antipsychotics , other psychotropic drugs , multiple antipsychotics , and daily dose ) except antidepressant use . In most cases these differences persisted even after adjusting for demographic and clinical characteristics ( age , sex , and length of illness ) of the subjects . Antipsychotics were usually prescribed in divided daily doses in combination with one or more other psychotropic drugs , including anticholinergics , anticonvulsants , benzodiazepines , and non-benzodiazepine hypnotics .  Anticholinergic use was more common with typical antipsychotics . Rates of atypical antipsychotic drug use were lowest in the Japanese center . The Japanese center had by far the highest mean daily dose of antipsychotics .  CONCLUSIONS The results indicate that prescription patterns in different centers do not follow any specific guidelines for the treatment of schizophrenia . The results also confirm previous findings that prescribing practice s for schizophrenia vary greatly among centers and countries . A common prescribing pattern found was the use of atypical antipsychotic drugs in combination with psychotropic drugs , such as anticholinergics , hypnotics , anticonvulsants , and benzodiazepines , administered in multiple daily doses The study reported herein a r and omized controlled trial was conducted to test the effectiveness of a nurse-led , needs-based psycho-education program for Chinese patients with first-onset mental illness over a 6-month follow-up . Ninety-six families of Chinese patients with schizophrenia newly referred to one outpatient clinic in Hong Kong were r and omly assigned to a nurse-led psycho-education program or usual outpatient care , each comprising 48 subjects . The patients ' mental health , illness insight , self-efficacy , services utilization , and hospitalization rates were measured at recruitment and at one week and six months post-intervention . The patients in the psycho-education program reported significantly greater improvements in mental health , insights into treatment and illness , and hospitalization rates over the 6-month follow-up , when compared with those who received usual care . The findings provide evidence that the needs-based , nurse-led psycho-education program can improve the health conditions and treatment insights of Chinese out- patients with first-onset mental illness CONTEXT Antipsychotic drugs are limited in their ability to improve the overall outcome of schizophrenia . Adding psychosocial treatment may produce greater improvement in functional outcome than does medication treatment alone . OBJECTIVE To evaluate the effectiveness of antipsychotic medication alone vs combined with psychosocial intervention on outcomes of early-stage schizophrenia . DESIGN R and omized controlled trial . SETTING Ten clinical sites in China . PARTICIPANTS Clinical sample of 1268 patients with early-stage schizophrenia treated from January 1 , 2005 , through October 31 , 2007 . Intervention Patients were r and omly assigned to receive antipsychotic medication treatment only or antipsychotic medication plus 12 months of psychosocial intervention consisting of psychoeducation , family intervention , skills training , and cognitive behavior therapy administered during 48 group sessions . MAIN OUTCOME MEASURES The rate of treatment discontinuation or change due to any cause , relapse or remission , and assessment s of insight , treatment adherence , quality of life , and social functioning . RESULTS The rates of treatment discontinuation or change due to any cause were 32.8 % in the combined treatment group and 46.8 % in the medication-alone group . Comparisons with medication treatment alone showed lower risk of any-cause discontinuation with combined treatment ( hazard ratio , 0.62 ; 95 % confidence interval , 0.52 - 0.74 ; P < .001 ) and lower risk of relapse with combined treatment ( 0.57 ; 0.44 - 0.74 ; P < .001 ) . The combined treatment group exhibited greater improvement in insight ( P < .001 ) , social functioning ( P = .002 ) , activities of daily living ( P < .001 ) , and 4 domains of quality of life as measured by the Medical Outcomes Study 36-Item Short Form Health Survey ( all P < or = .02 ) . Furthermore , a significantly higher proportion of patients receiving combined treatment obtained employment or accessed education ( P = .001 ) . CONCLUSION Compared with those receiving medication only , patients with early-stage schizophrenia receiving medication and psychosocial intervention have a lower rate of treatment discontinuation or change , a lower risk of relapse , and improved insight , quality of life , and social functioning . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00654576
Findings related to effectiveness ( treatment discontinuation , quality of life , and neurocognitive improvements ) were generally consistent with those observed in non-Chinese population s. No new safety signals specific for Chinese population s were raised for olanzapine .
Chinese and non-Chinese population s with schizophrenia or bipolar disorder treated with olanzapine display broadly similar responses .
BACKGROUND Despite the burden of schizophrenia and bipolar disorder in the Chinese population , country-specific data to guide practitioners regarding antipsychotic therapy are lacking .