4.1 Schizophrenia requires comprehensive prevention and control in Fuzhou
Herein, of 30,362 registered SMD patients, schizophrenia had the highest number (86.31%), followed by mental retardation (with mental disorders) (6.98%), while paranoid psychosis had the least (0.15%), consistent with research results of many scholars, such as Liao Zhixian . Therefore, severe Schizophrenia and mental retardation (associated with mental disorders) are key diseases in Fuzhou that need comprehensive prevention
Schizophrenia is a chronic mental illness with the most severe symptoms and is the most difficult to treat. Schizophrenia patients have rigid eyes, are sensitive and suspicious, have unreasonable tension, fear, psychological changes, are easily irritable, have low self-care ability, are antisocial, etc. Severe schizophrenia may lead to suicide or other injuries. Most studies  have shown that women, with high education levels, married, late onset, acute or subacute onset, cheerful personality before the disease, good interpersonal relations, and good social mechanisms and functions before the disease. Negative symptoms are diagnosed as the main clinical phase. Strong family social institutions and functions, timely treatment, systematic, and high compliance can positively enhance disease treatment. Moreover, the above are considered as evaluation indexes for poor treatment effects.
Presently, typical or atypical antipsychotics are mainly used to treat SMD. Meanwhile, targeted psychological care can effectively stabilize the patient’s mood, increase emotional experience and expression, reduce psychological pressure, and effectively improve the patient’s psychological state and reduce the disease burden. Many experts and scholars, including Fan ChiHsuan, have shown that support from family and other communities can effectively reduce the severity of schizophrenia symptoms in various patients. Therefore, the patient’s family and community should improve their relationship with the patient to enhance monitoring and management of the symptoms of SMD patients. Furthermore, schizophrenia in some families has been solved through improved social relationships.
About 60% of SMD cases can be treated and relieved via socialization due to the continuous development and technological advancement of modern therapeutics in China in recent years.
4.2 Comprehensive prevention and control of SMD in Fuzhou should focus on poor and patients with low educational backgrounds
This study showed that more men suffer from SMD than women in Fuzhou, consistent with Alejandra Caqueo-Urízar and other scholars, suggesting that it may be related to mental stress in daily life and work environment.
Most SMD patients are 18 (inclusive)-44 years old (45.38%) and 45 (inclusive)-59 years old (33.75%). Married people have SMD. These two age groups and married people bear more stress from school, family, work, and life, and face more emergencies, leading to a heavy mental load. Therefore, the Fuzhou Municipal Government should strengthen mental health education among young people and adults and address family mental health problems.
Most SMD patients had a primary education level and below (including semi-illiterate) (54.17%). Most people with low educational levels have little knowledge of mental health. Therefore, they would not seek medical services when they have mental health problems occur. In contrast, people with a higher level of education know more about mental illness and can seek medical attention as soon as possible. The number of SMD patients is relatively small among people with a high level of education compared with those with low educational level. In addition, people with low educational levels may have difficulty adapting to the rapidly changing society, have poor psychological quality, and are more likely to have a pessimistic mood and behavior. Moreover, people with mental illness are more likely to be unemployed or are under long-term hospitalization, leading to economic difficulties.
Also, Most SMD patients were farmers (30.23%) and laid-off or unemployed (25.18%). The proportion of the poor and those below the local poverty line was 55.35%, higher than other cases. Farmers, laid-off workers, and the unemployed have low incomes and poor living standards. They are more likely to have psychological problems when encountered with emergencies. They lose hope in the future and are more likely to be managed by the government.
In summary, most SMD patients have a low educational level. Therefore, the government should pay more attention to these disadvantaged groups, improve the medical insurance system, and sensitize on mental health to reduce the incidence of mental illness. Besides, the relatively high rates of unmarried and divorced patients with SMD indicate that society discriminates against them and is unwilling to interact with them. The government and communities should also spread mental health awareness among the general public to eliminate discrimination.
4.3 The prevalence of SMD in Fuzhou is lower in urban areas than in non-urban areas and has an increasing trend
Herein, Minqing County had the highest prevalence rate of SMD (5.79‰), while Mawei District had the lowest (3.80‰). The time-point prevalence of SMD (4.05‰) was lower in the six urban areas than in the six non-urban areas (4.32‰). Therefore, SMD is common in non-urban areas because mental health awareness is more effective in urban areas than in non-urban areas. Therefore, mental health joint conference system is necessary for the districts, counties and sub-districts of Fuzhou Health promotion links. Besides, the reporting system should be improved to increase the consciousness of Fuzhou residents to seek medical treatment.
Furthermore, SMD prevalence in Fuzhou City increased from March 2018 to September 2018. The prevalence rate also slightly increased in these months because SMD is a longer course disease. SMD often recurs, is more difficult to cure, has a small migration, and the patient’s residence is relatively fixed. Therefore, community and hospital staff should conduct regular-follow up, assess the medication status of SMD patients discharged from the hospital, and educate family members on the importance of ensuring the patient takes medication. Meanwhile, public awareness of SMD should be further strengthened to prevent and reduce SMD cases.
4.4 The medication and management rates of SMD patients in Fuzhou are higher in urban areas than in non-urban areas
WHO defines medication compliance as the degree of consistency between an individual’s medication use and the doctor’s prescription. Most scholars have focused on the medication compliance of SMD patients as early as the 1970s. Medication treatment is the most effective method for improving SMD. Besides, the government has issued corresponding subsidy policies, greatly reduce the cost of treating SMD patients, burden, preventing patients’ irregular visits to doctors and random medication, reducing disease fluctuations, attracting patients into community management[16-17].
Herein, the taking-rate and the regular taking-rate of registered SMD patients were 75.72% and 57.67%, respectively. Presently, the national taking-rate and regular taking-rate among SMD patients are 81.30%and is 41.78%, respectively. Therefore, the rate of taking drugs is significantly lower than that of the current national level, while the rate of regular-taking is higher than that of the national level . Furthermore, the medication and regular medication rates were significantly different between urban and non-urban areas in Fuzhou. Based on different SMD types, the medication and regular medication rates were significantly higher in the six urban areas than in the non-urban area. This could be because urban area has better medical resources and talent facilities than the non-urban areas, guaranteeing quality medical treatment. Moreover, community rehabilitation staff in urban areas are well-trained and can supervise SMD patients better than in non-urban areas. Therefore, patients in urban areas have access to more standardized management. Also, patients in urban areas have a higher education level, better ways of obtaining disease-related knowledge through multiple channels, and higher medication compliance than patients in non-urban areas . Herein, the rate of medication and regular medication was highest for mental disorders caused by epilepsy, consistent with the results of Nesvåg Ragnar and other scholars, suggesting that there are positive symptoms of schizophrenia, such as hallucinations. Some patients who have delusions believe that they are being persecuted and have poor medication compliance. The more serious the positive symptoms before treatment, the worse the medication compliance.
Among patients with recurrent schizophrenia for the first time, 75% of patients maintain effective treatment through drugs and clinical treatments. However, the rate of patients with recurrent episodes or severe deterioration could be higher in the future, and antipsychotic drugs can prevent its recurrence. Population and sociological factors, disease-related factors, psychological factors, drug-related factors, and other social support affect medication compliance in schizophrenia patients. Therefore, medical staff should assess the medication compliance of patients with mental disorders and the main influencing factors of non-compliance and offer individualized intervention strategies.
The management rate of SMD patients in Fuzhou was significantly lower (10.09%) than the current national management rate (82.69%). Also, the management rate was significantly higher in urban areas than in non-urban areas, possibly because the management system is more effective in urban areas than in non-urban areas.
Moreover, patients in non-urban areas often go out for work, making it difficult for community rehabilitation workers and medical staff to manage them in a unified manner. Therefore, the government should strengthen the work quality of non-urban psychiatrists and improve the follow-up work in the community, targeted training of medical staff and family care management  to enhance the management rate of registered patients.