Noordsy D L, O'Keefe C, Mueser K T, Xie H
Mental Health Center of Greater Manchester, New Hampshire, USA.
Psychiatr Serv. 2001 Apr;52(4):501-7. doi: 10.1176/appi.ps.52.4.501.
This study evaluated the outcomes of patients in a community mental health center who switched from treatment with another antipsychotic to olanzapine treatment. It also sought to determine whether simultaneous access to case management and psychosocial rehabilitation and olanzapine leads to enhanced functional improvement.
Six-month outcomes for a consecutive series of 104 patients who switched from a conventional antipsychotic medication to olanzapine were evaluated. Forty-nine patients in the same treatment program who continued to take conventional antipsychotics were also monitored as a reference group. Outcomes of the group receiving olanzapine were compared with their own baseline status and with outcomes of the reference group.
At six months, patients in the olanzapine group demonstrated significant improvement over baseline across multiple measures of symptoms and psychosocial function. Compared with the reference group, the olanzapine group was more symptomatic at baseline and demonstrated significantly greater improvement at follow-up on the Brief Psychiatric Rating Scale and all subscales; Mini Psychiatric Rating Scale negative symptom, disorganization, anxiety, depression, and medication side effects items; and Clinical Global Improvement scale and Case Manager's Rating Scale-Plus illness factors. There was a trend toward superior improvement in psychosocial functioning among patients in the olanzapine group that achieved significance when patients in acute relapse at baseline were excluded.
Olanzapine is effective in managing markedly to severely ill patients with psychotic disorders in a community mental health center. Simultaneous treatment with olanzapine, case management, and psychosocial rehabilitation leads to enhanced functional improvement among nonrelapsing patients.
本研究评估了社区心理健康中心中从使用其他抗精神病药物转为使用奥氮平治疗的患者的治疗结果。研究还试图确定同时接受个案管理和心理社会康复以及奥氮平治疗是否能带来功能改善的增强。
对连续104例从传统抗精神病药物转为使用奥氮平的患者进行了为期6个月的治疗结果评估。在同一治疗项目中继续服用传统抗精神病药物的49例患者也作为参照组进行监测。将接受奥氮平治疗组的结果与其自身的基线状态以及参照组的结果进行比较。
6个月时，奥氮平组患者在多项症状和心理社会功能指标上较基线有显著改善。与参照组相比，奥氮平组在基线时症状更多，在随访时，在简明精神病评定量表及其所有子量表、简易精神病评定量表阴性症状、紊乱、焦虑、抑郁和药物副作用项目、临床总体改善量表和个案管理员评定量表加疾病因素方面有显著更大的改善。当排除基线时急性复发的患者后，奥氮平组患者在心理社会功能改善方面有更优趋势，且具有统计学意义。
在社区心理健康中心，奥氮平对患有精神障碍的明显至重度疾病患者有效。奥氮平、个案管理和心理社会康复同时治疗可使非复发患者的功能改善增强。
