精神分裂症復發危險因子之探討－Cox 比例危害模式存活分析之應用

目的：本研究有別於一般統計法，先根據文獻，將影響精神分裂復發的因素作為研究變項，利用存活分析探討精神分裂症的復發受哪些因子的影響，並找出在病歷中，最能預測復發的危險因子。方法：研究對象為台灣南部某區域教學醫院、經專業精神科醫師診斷為精神分裂症（診斷代碼：295.0-295.9）之94 個案。所有個案條件均符合發病後首次住院，在觀測期的五年內（2001-2005），因復發而再入院的52 人（55.32％）為復發組；未復發的42 人（44.68 ％）為未復發組，並根據文獻參照病歷將個案的預後、護理診斷、社工評估以及COTE 量表各項總分紀錄於調查問卷成變項，再利用Cox 比例危害模式的存活分析，找出可顯著預測精神分裂症患者復發的危險因子，並以風險危害比（hazard ratio,HR），以及HR 之95％ CI 分別表示其危害程度。結果：經Cox 比例危害模式的存活分析，結果發現，在所有危害因子當中，家中排行老大的個案以及與家人有衝突之個案，有顯著的復發危害比。與家人有衝突的個案，復發危害比是與家人沒有衝突個案的約4.8 倍（p＝0.004）， HR 之95％ CI 危害程度為 0.071-0.613；家中排行老大的個案，復發危害比是排行其它的2.95 倍（p＝0.049），HR 之95％ CI 危害程度為0.116-0.995。在社工評估中，與父親的關係越差，其復發率越高（p＝0.027）。結論：與家人有衝突、在家中排行老大及與父親關係差，為精神分裂症復發的危險因子。研究結果可進一步提供醫療團隊，除了僅針對病患身體疾病的醫療模式外，也應著重於對家庭取向之介入作為處遇之參考。

關鍵字

精神分裂復發； Cox 比例危害模式

並列摘要

Objective：The aim of this study was to use the method of the survival analysis of cox proportional hazards models to explore the risk factors of relapse in schizophrenia, according to several articles about this issues , the risk factors associated with the relapse in schizophrenia were investigated from the anamnesis. Methods：Cases consisted of 94 patients who were diagnosed as schizophrenia （295.0-295.9）by psychiatrists from one of the teaching hospital in southern Taiwan. All of these patients were required to have the condition of first hospitalization after the onset. During the five years of observation （2001-2005）, 52（55.32％）patients who were hospitalized once more due to the illness relapse belonged to the group of relapse；the remainders of 42 patients（44.68％）belonged to the group of not being relapsed. According to the literatures, patient＇s anamnesis of prognosis, nursing records, assessment of social workers and the measurements of COTE were turned into variables. Then, the survival analysis of COX proportional risk model was used to find out the hazard factors in predicting relapse in schizophrenia. Moreover, hazard ratio（HR）and 95 ％ Cl for HR would indicate the degree of relapse. Results：The results showed that if the first child or usually conflicts with the family was 4.8 times higher than the patients who never involves in a conflict（p＝0.004）；95％ Cl for HR would be 0.071-0.613；if the patient who is the first child of the family was 2.95 times higher to be illness relapse than other siblings（p＝0.049）. The relapse rate of patient who conflicted with family members was 4.8 times higher than whom didn＇t（p＝0.004）. 95％ Cl for HR was 0.071-0.613; the first child was 2.95 times higher than the other ranking children （p＝0.049）, and the 95％ Cl for HR would be 0.116-0.995.The social work assessment showed that the worse relationship with the father would result higher illness relapse （p＝0.027）. Conclusion：If the patient who is the first child and usually conflicts with family or if the patient has worse relationship with the father are the hazardous factors to cause illnss relapse in schizophrenia. The results can be a helpful reference for planning intervention and prevention programs for the prevention of relapse in schizophrenia.