Weinmann Stefan, Janssen Birgit, Gaebel Wolfgang
Department of Psychiatry and Psychotherapy, Heinrich Heine University Duesseldorf, Duesseldorf, Germany.
J Clin Psychiatry. 2004 Aug;65(8):1099-105. doi: 10.4088/jcp.v65n0812.
Within a pharmacoepidemiologic study, characteristics of patients with schizophrenia switched from first- to second-generation antipsychotics (FGAs and SGAs, respectively) or to antipsychotic polypharmacy were compared with those of patients maintained on treatment with FGAs. The primary aim was to assess factors associated with antipsychotic switching and to compare disease course with regard to mental state and social functioning.
Adult inpatients with an ICD-10 diagnosis of schizophrenia or schizoaffective disorder were assessed in 7 psychiatric hospitals. Data were collected between 2001 and 2002. For those patients (N = 847) with an antipsychotic prescription at discharge, t tests and covariance and logistic regression analyses were used to evaluate the relationship between demographic and clinical characteristics and antipsychotic switching.
Patients switched from FGAs to SGAs had fewer previous psychiatric admissions, a shorter illness duration, fewer substance disorders, and a higher probability of working in a competitive setting but more pronounced symptoms than those maintained on treatment with FGAs. Mental state and social functioning after case-mix adjustment were more favorable in the group switched to SGA monotherapy but not in those patients administered FGAs and SGAs concurrently at discharge. Logistic regression controlling for demographic and clinical variables revealed that a short disease duration (p <.05), fewer previous psychiatric hospitalizations (p <.01), voluntary admission (p <.05), and pronounced thought disorder (p <.05) were significantly associated with switching from FGAs to SGAs. Hospital differences were also observed.
Remaining on FGAs or switching to SGAs in schizophrenia care depends strongly on institutional practices in addition to the previous disease course and health care utilization.
在一项药物流行病学研究中，将从第一代抗精神病药物（FGA）转换为第二代抗精神病药物（SGA）或采用抗精神病药物联合治疗的精神分裂症患者的特征，与持续接受FGA治疗的患者特征进行了比较。主要目的是评估与抗精神病药物转换相关的因素，并比较在精神状态和社会功能方面的疾病进程。
对7家精神病医院中诊断为ICD - 10精神分裂症或分裂情感性障碍的成年住院患者进行评估。数据收集于2001年至2002年期间。对于出院时开具抗精神病药物处方的患者（N = 847），采用t检验、协方差分析和逻辑回归分析来评估人口统计学和临床特征与抗精神病药物转换之间的关系。
从FGA转换为SGA的患者既往精神病住院次数较少、病程较短、物质障碍较少，在竞争性环境中工作的可能性较高，但症状比持续接受FGA治疗的患者更明显。病例组合调整后的精神状态和社会功能在转换为SGA单药治疗的组中更有利，但在出院时同时使用FGA和SGA的患者中并非如此。控制人口统计学和临床变量的逻辑回归显示，病程短（p <.05）、既往精神病住院次数少（p <.01）、自愿入院（p <.05）和明显的思维障碍（p <.05）与从FGA转换为SGA显著相关。还观察到医院之间的差异。
在精神分裂症治疗中，继续使用FGA或转换为SGA除了取决于既往病程和医疗保健利用情况外，还在很大程度上取决于机构的做法。
