Objective:To investigate the prevalence of infectious diarrhea among older adult patients with schizophrenia, identify the influential factors, and construct a nomogram prediction model for infectious diarrhea.Methods:This study is a prospective cohort study that used convenience sampling to select 160 older patients with schizophrenia from three psychiatric hospitals in Wenzhou (85 cases from Wenzhou Seventh People's Hospital, 40 cases from Lucheng Third People's Hospital, and 35 cases from The Affiliated Kangning Hospital of Wenzhou Medical University) who were admitted between January 2022 and December 2023. The prevalence of infectious diarrhea and its influential factors were statistically analyzed. Regression analysis was conducted to develop a risk prediction model for infectious diarrhea, which was presented using a nomogram.Results:A total of 160 older adult patients with schizophrenia were aged between 61 and 79 years, with an average age of (67.82 ± 7.56) years. Among these patients, 53 were female (33.13%), and 107 were male (66.87%). Thirty-four patients experienced infectious diarrhea, with an incidence rate of 21.25%. Univariate analysis revealed significant differences in body mass index ( χ2 = 9.36, P = 0.009), history of diarrhea ( χ2 = 4.52, P = 0.033), disinfection of tableware ( χ2 = 4.16, P = 0.04), handwashing before and after meals ( χ2 = 6.11, P = 0.013), intestinal flora disorder ( χ2 = 19.43, P < 0.001), CD 4+/CD 8+ ratio ( t = 12.37, P < 0.001), interleukin-17 ( t = 15.86, P < 0.001), and fecal secretory IgA ( t = 20.18, P < 0.001) in older adult patients with schizophrenia. Multifactorial analysis indicated that body mass index ( OR = 0.733), disinfection of tableware ( OR = 0.733), handwashing before and after meals ( OR = 0.452), CD 4+/CD 8+ ratio ( OR = 0.359), interleukin-17 ( OR = 0.563), and fecal secretory IgA ( OR = 0.455) were protective factors against infectious diarrhea in older adult patients with schizophrenia (all P < 0.05). Conversely, a history of diarrhea ( OR = 1.774) and intestinal flora disorder ( OR = 1.528) were identified as risk factors for infectious diarrhea in this population (both P < 0.05). Conclusions:The influential factors for the occurrence of infectious diarrhea in older adult patients with schizophrenia include body mass index, history of diarrhea, disinfection of tableware, handwashing before and after meals, intestinal flora disorder, CD 4+/CD 8+ ratio, interleukin-17, and fecal secretory IgA levels. Future studies should conduct longitudinal research to optimize the prediction model and establish a dynamic nomogram model. This will provide nurses with a reliable tool for dynamically predicting the occurrence of infectious diarrhea in older adult patients with schizophrenia, with the aim of reducing the incidence of infectious diarrhea and improving the patients' quality of life.

Objective:To investigate the prevalence of infectious diarrhea among older adult patients with schizophrenia, identify the influential factors, and construct a nomogram prediction model for infectious diarrhea.Methods:This study is a prospective cohort study that used convenience sampling to select 160 older patients with schizophrenia from three psychiatric hospitals in Wenzhou (85 cases from Wenzhou Seventh People's Hospital, 40 cases from Lucheng Third People's Hospital, and 35 cases from The Affiliated Kangning Hospital of Wenzhou Medical University) who were admitted between January 2022 and December 2023. The prevalence of infectious diarrhea and its influential factors were statistically analyzed. Regression analysis was conducted to develop a risk prediction model for infectious diarrhea, which was presented using a nomogram.Results:A total of 160 older adult patients with schizophrenia were aged between 61 and 79 years, with an average age of (67.82 ± 7.56) years. Among these patients, 53 were female (33.13%), and 107 were male (66.87%). Thirty-four patients experienced infectious diarrhea, with an incidence rate of 21.25%. Univariate analysis revealed significant differences in body mass index ( χ2 = 9.36, P = 0.009), history of diarrhea ( χ2 = 4.52, P = 0.033), disinfection of tableware ( χ2 = 4.16, P = 0.04), handwashing before and after meals ( χ2 = 6.11, P = 0.013), intestinal flora disorder ( χ2 = 19.43, P < 0.001), CD 4+/CD 8+ ratio ( t = 12.37, P < 0.001), interleukin-17 ( t = 15.86, P < 0.001), and fecal secretory IgA ( t = 20.18, P < 0.001) in older adult patients with schizophrenia. Multifactorial analysis indicated that body mass index ( OR = 0.733), disinfection of tableware ( OR = 0.733), handwashing before and after meals ( OR = 0.452), CD 4+/CD 8+ ratio ( OR = 0.359), interleukin-17 ( OR = 0.563), and fecal secretory IgA ( OR = 0.455) were protective factors against infectious diarrhea in older adult patients with schizophrenia (all P < 0.05). Conversely, a history of diarrhea ( OR = 1.774) and intestinal flora disorder ( OR = 1.528) were identified as risk factors for infectious diarrhea in this population (both P < 0.05). Conclusions:The influential factors for the occurrence of infectious diarrhea in older adult patients with schizophrenia include body mass index, history of diarrhea, disinfection of tableware, handwashing before and after meals, intestinal flora disorder, CD 4+/CD 8+ ratio, interleukin-17, and fecal secretory IgA levels. Future studies should conduct longitudinal research to optimize the prediction model and establish a dynamic nomogram model. This will provide nurses with a reliable tool for dynamically predicting the occurrence of infectious diarrhea in older adult patients with schizophrenia, with the aim of reducing the incidence of infectious diarrhea and improving the patients' quality of life.

Objective:To analyze the changes and clinical significance of homocysteine (Hcy), folate, and cardiac enzyme levels in patients with alcohol dependence and depression.Methods:A total of 102 patients with alcohol dependence and depression, who received treatment at Wenzhou Seventh People's Hospital from January 2022 to June 2023, were included in the observation group. The degree of alcohol dependence in patients in the observation group was assessed using the Michigan Alcoholism Screening Test (MAST). According to the assessment results, the patients in the observation group were divided into the following subgroups: mild alcohol dependence ( n = 33), moderate alcohol dependence ( n = 37), heavy alcohol dependence ( n = 15), and severe alcohol dependence ( n = 17). The severity of depression among patients in the observation group was assessed with the Hamilton Depression Scale (HAMD). Based on the assessment results, the patients in the observation group were divided into the following subgroups: mild depression ( n = 43), moderate depression ( n = 34), and severe depression ( n = 25). The cognitive function of patients in the observation group was assessed using the Montreal Cognitive Assessment Scale (MoCA). According to the assessment results, the patients in the observation group were divided into normal cognitive function ( n = 73) and cognitive impairment ( n = 29) subgroups. Thirty healthy volunteers from our hospital during the same period were included in the control group. The levels of Hcy, folate, and cardiac enzymes were compared among all groups. The correlations between Hcy, folate, and cardiac enzyme levels with HAMD, MoCA, and MAST scores were analyzed using the Pearson method. Results:The Hcy level in the observation group was (15.21 ± 1.99) μg/L, which was significantly higher than that in the control group [(11.38 ± 1.46) μg/L, t = -9.80, P < 0.001]. The levels of folate, lactate dehydrogenase (LDH), and creatine kinase (CK) in the observation group were (4.82 ± 1.77) μg/L, (122.69 ± 33.98) IU/L, and (87.83 ± 16.52) IU/L, respectively, which were significantly lower than those in the control group [(6.27 ± 1.35) μg/L, (150.56 ± 38.78) IU/L, (98.67 ± 20.29) IU/L, t = 4.16, 3.82, 2.99, all P < 0.05]. The Hcy levels in the mild , moderate, heavy, and severe alcohol dependence subgroups [(13.16 ± 1.23) μg/L, (15.35 ± 0.82) μg/L, (16.79 ± 1.38) μg/L, (17.63 ± 1.22) μg/L] increased sequentially, while the folate levels [(6.11 ± 1.51) μg/L, (4.95 ± 1.40) μg/L, (4.04 ± 0.99) μg/L, (2.70 ± 0.99) μg/L], LDH levels [(153.35 ± 27.47) IU/L, (123.29 ± 16.59) IU/L, (109.83 ± 14.41) IU/L, (73.24 ± 16.86) IU/L], and CK levels [(104.14 ± 12.78) IU/L, (86.48 ± 9.15) IU/L, (78.11 ± 7.85) IU/L, (67.71 ± 9.00) IU/L] decreased sequentially. These differences in Hcy, folate, LDH, and CK levels among the mild, moderate, heavy, and severe alcohol dependence subgroups were statistically significant ( F = 73.24, 26.53, 59.08, 53.86, all P < 0.001). The Hcy levels in the mild, moderate, and severe depression subgroups [(13.75 ± 1.54) μg/L, (15.46 ± 1.17) μg/L, (17.39 ± 1.31) μg/L] increased progressively, while the folate levels [(5.83 ± 1.77) μg/L, (4.67 ± 1.12) μg/L, (3.28 ± 1.26) μg/L], LDH levels [(138.09 ± 33.67) IU/L, (119.73 ± 26.39) IU/L, (100.24 ± 30.88) IU/L], and CK levels [(96.35 ± 15.24) IU/L, (86.73 ± 15.62) IU/L, (74.69 ± 9.71) IU/L] decreased progressively. The differenes in Hcy, folate , LDH, and CK levels among the four depression subgroups were statistically significant ( F = 56.57, 24.36, 12.23, 18.44, all P < 0.001). The Hcy levels in the cognitive impairment group [(17.01 ± 1.63) μg/L] was significantly higher than that in the normal cognitive function group [(14.50 ± 1.64) μg/L, t = -6.97, P < 0.001), and the folate, LDH, and CK levels in the cognitive impairment group were (3.76 ± 1.78) μg/L, (102.71 ± 31.08) IU/L, and (76.00 ± 13.37) IU/L respectively, which were significantly lower than those in the normal cognitive function group [(5.24 ± 1.58) μg/L, (130.63 ± 31.92) IU/L, (92.52 ± 15.31) IU/L, t = 4.11, 4.01, 5.09, all P < 0.001]. Hcy levels were positively correlated with HAMD and MAST scores ( r = 0.854, 0.846, both P < 0.05) and negatively correlated with MoCA scores ( r = -0.648, P < 0.001). Folate, LDH, and CK levels were negatively correlated with HAMD and MAST scores ( r = -0.644, -0.701; r = -0.551, -0.696; r = -0.505, -0.673; all P < 0.001), and they were positively correlated with MoCA scores ( r = 0.514, 0.436, 0.448, all P < 0.001). Conclusion:In patients with alcohol dependence and depression, abnormal levels of Hcy, folate, and cardiac enzymes were observed. These indicators were found to be associated with the severity of alcohol dependence, the level of depression, and cognitive function.

Objective:To investigate the effect of clozapine on endocrine hormone levels in patients with schizophrenia, and to analyze the factors causing metabolic abnormality.Methods:The clinical data of 102 patients with schizophrenia who received treatment at the Wenzhou Seventh People's Hospital from January 2021 to January 2023 were retrospectively analyzed. All patients were treated with clozapine. They were divided into a normal metabolism group ( n = 76) and a metabolic abnormality group ( n = 26) according to whether or not metabolic abnormality occurred after treatment. The glycolipid metabolism levels, thyroid function, and gonadal hormone levels were recorded and compared between the two groups. Logistic regression analysis was then performed to determine the relevant factors influencing the occurrence of concurrent metabolic abnormality in these patients. Results:After treatment, the levels of triglyceride, low-density lipoprotein, glycosylated hemoglobin, triiodothyronine, and prolactin in patients were all significantly increased compared with those measured before treatment, while estradiol level was significantly decreased compared with that measured before treatment ( t = 2.84, 3.36, 25.35, 3.26, 4.88, -5.76, all P < 0.05). Body mass index, disease duration, and the levels of triglyceride, glycosylated hemoglobin, triiodothyronine, and prolactin in the metabolic abnormality group were significantly higher than those in the normal metabolism group, while the levels of low-density lipoprotein, FT 4, and estradiol in the metabolic abnormality group were significantly lower than those in the normal metabolism group ( t = 4.41, 5.67, 3.20, 4.71, 3.49, 3.97, -4.84, -4.51, -4.25, all P < 0.05). The results of the logistic regression analysis indicated that high body mass index ( OR = 7.410, 95% CI = 1.485-36.988), prolonged disease duration ( OR = 1.385, 95% CI = 1.088-1.764), low low-density lipoprotein level ( OR = 0.003, 95% CI = 0.000-0.453), elevated glycosylated hemoglobin level ( OR = 4.222, 95% CI = 1.067-16.706), decreased FT 4 level ( OR = 0.238, 95% CI = 0.086-0.655), and low estradiol level ( OR = 0.845, 95% CI = 0.726-0.984) were the factors associated with metabolic abnormality (all P < 0.05). Conclusion:The use of clozapine in the treatment of schizophrenia will affect the patient's glycolipid metabolism, thyroid function, and gonadal hormone levels. At the same time, it is found that high body mass index, long disease duration, low low-density lipoprotein level, high glycosylated hemoglobin level, low FT 4 level, and low estradiol level will increase the risk of metabolic abnormality in patients. Therefore, targeted interventions should be carried out according to the actual situation.