MORBIDITY IN SCHIZOPHRENIA--A FOCUS ON DIABETES

精神分裂症患者的死亡率明显高于 比一般人群中的人。 很可能 可改变的患者行为和医疗保健提供系统 这些特征促成了这种现象。查明这类 可修改的患者和医疗保健系统因素可能是关键的， 改善精神分裂症患者的健康状况和寿命。 由于这个问题的复杂性，我们选择了一个“跟踪器”条件 战略，重点关注单一疾病--糖尿病，作为一种 典型的严重的慢性医学问题， 推广到其他疾病。 糖尿病是一种高度流行的慢性 需要积极自我护理的医学疾病， 一种理解问题的原型障碍， 精神分裂症和其他严重精神疾病在获得和 利用适当的医疗护理。 使用健康信念模型作为 一个概念框架，这项研究将比较100人， 患有糖尿病的精神分裂症患者与100名抑郁症患者， 向100名没有严重和持续性精神疾病的人提供援助， 从糖尿病到：1）糖尿病特有的健康行为（例如， 依从性）、健康结果（血糖控制）和 接受糖尿病护理; 2）潜在的中介变量，假设 区分精神分裂症患者和非精神分裂症患者，包括 糖尿病健康信念和疾病知识。 其他分析将 将精神分裂症样本与糖尿病特异性 措施 我们还将研究系统特性（例如， 综合身体护理和精神护理）和临床 特性（例如，社会技能和症状）占穷人 精神分裂症和重性抑郁症患者的结局。 精神分裂症和重度抑郁症患者将从一个 巴尔的摩地区的各种精神健康中心。 匹配 样本将从马里兰州大学的家庭诊所抽取 诊所 患者将接受一次评估和病历审查。 因此，这项建议的重点是糖尿病和精神分裂症，虽然我们的 一个潜在的假设是，我们的发现将有助于我们的 了解其他医疗疾病的管理和结果， 精神分裂症患者。

Persons with schizophrenic disorders have significantly higher mortality rates than persons in the general population. It is likely that modifiable patient behaviors and health care delivery system characteristics contribute to this phenomenon. Identification of such modifiable patient and health care system factors may be critical to improving the health status and longevity of persons with schizophrenia. Due to the complexity of this issue, we selected a "tracer" condition strategy, focusing on a single medical disease, diabetes, as a prototypical serious, chronic medical problem from which lessons may generalize to other disorders. Diabetes is a highly prevalent chronic medical disorder which requires active self-care and which may serve as a prototype disorder to understand problems that persons with schizophrenia and other severe mental illnesses have in obtaining and making use of adequate medical care. Using the health beliefs model as a conceptual framework, this study will compare 100 persons with schizophrenia who have diabetes to 100 persons with major depression and to 100 persons without serious and persistent mental illness who suffer from diabetes on: 1) diabetes-specific health behaviors (e.g., compliance), health outcomes (control of blood sugar), and quality of diabetes care received; 2) potential mediating variables, hypothesized to differ between schizophrenics and non-schizophrenics, including diabetes health beliefs and illness knowledge. Additional analyses will compare the schizophrenia sample to published norms on diabetes-specific measures. We will also examine whether system characteristics (e.g., integration of physical care and psychiatric care) and clinical characteristics (e.g., social skills and symptoms) account for poorer outcomes among persons with schizophrenia and major depression. Patients with schizophrenia and major depression will be drawn from a variety of mental health centers in the Baltimore area. A matched sample will be drawn from a University of Maryland Family Practice Clinic. Patients will receive a single assessment and chart review. This proposal thus focuses on diabetes and schizophrenia, although our underlying assumption is that our findings will contribute to our understanding of management and outcomes of other medical illnesses in persons with schizophrenia.