Valenstein M, Copeland L A, Owen R, Blow F C, Visnic S
Department of Veterans Affairs, Serious Mental Illness Treatment Evaluation, and Research Center, Ann Arbor, Mich 48113-0170, USA.
J Clin Psychiatry. 2001 Jul;62(7):545-51. doi: 10.4088/jcp.v62n07a08.
Antipsychotic medications significantly ameliorate the symptoms of schizophrenia, but patients are often noncompliant with these medications. Research evidence supports the use of depot antipsychotics in noncompliant patients.
Between January 9, 1991, and December 19, 1995, 1307 veterans with schizophrenia or schizoaffective disorder (ICD-9) were enrolled in a study of enhanced psychosocial programming at 14 Veterans Administration Medical Centers. All had a history of high inpatient use. At enrollment, clinicians listed patient medications, rated patient compliance, and completed a Brief Psychiatric Rating Scale (BPRS) and Global Assessment of Functioning (GAF). Patients reported medication side effects. We describe depot antipsychotic use among these patients and examine the relationship between depot use, assessed compliance, and patient characteristics.
At enrollment, 18% of patients in this cohort were receiving depot antipsychotics; however, clinicians reported that 49% had been noncompliant with medication in the past year. Depot use varied significantly with treatment site; African Americans were more likely to receive depot antipsychotics and less likely to receive atypical antipsychotics than white patients. Patients on depot and oral agents had similar levels of psychiatric symptoms, but patients on depot antipsychotics were more likely to receive high doses and complain of side effects.
Clinicians prescribed depot antipsychotics relatively infrequently, despite high rates of noncompliance and high levels of inpatient use. Variation in use with treatment site and ethnic group suggests barriers to implementing research-based recommendations for depot use in noncompliant patients. Quality improvement programs should consider facilitating the appropriate use of depots.
抗精神病药物能显著改善精神分裂症症状，但患者往往不遵医嘱服药。研究证据支持在不遵医嘱的患者中使用长效抗精神病药物。
在1991年1月9日至1995年12月19日期间，1307名患有精神分裂症或分裂情感性障碍（ICD - 9）的退伍军人参加了在14家退伍军人管理局医疗中心开展的强化心理社会项目研究。所有患者都有较高的住院使用率。在入组时，临床医生列出患者所服用的药物，评估患者的依从性，并完成简明精神病评定量表（BPRS）和功能总体评定量表（GAF）。患者报告药物副作用。我们描述了这些患者中长效抗精神病药物的使用情况，并研究了长效药物使用、评估的依从性和患者特征之间的关系。
入组时，该队列中18%的患者正在接受长效抗精神病药物治疗；然而，临床医生报告称，在过去一年中有49%的患者不遵医嘱服药。长效药物的使用在不同治疗地点有显著差异；与白人患者相比，非裔美国人更有可能接受长效抗精神病药物治疗，而接受非典型抗精神病药物治疗的可能性较小。使用长效药物和口服药物的患者精神症状水平相似，但使用长效抗精神病药物的患者更有可能接受高剂量药物治疗，并抱怨有副作用。
尽管不遵医嘱服药的比例很高且住院使用率也很高，但临床医生相对较少开具长效抗精神病药物。不同治疗地点和种族群体在药物使用上的差异表明，在不遵医嘱的患者中实施基于研究的长效药物使用建议存在障碍。质量改进项目应考虑促进长效药物的合理使用。
