McEvoy Joseph P
John Umstead Hospital, 1003 12th Street, Butner, NC 27509, USA.
J Clin Psychiatry. 2006;67 Suppl 5:15-8.
Since their introduction into clinical practice in the early 1960s, long-acting depot antipsychotics have been widely used as maintenance therapy for patients with schizophrenia. The improved pharmacokinetics of injectable long-acting antipsychotic therapies have provided more reliable drug delivery and reduced differences in peak and trough plasma levels of the drug. Studies that have compared short-acting oral antipsychotics with long-acting injectable antipsychotics, although imperfect, support injectable antipsychotics as having real benefit over oral antipsychotics on patient outcome owing largely to improved adherence. If patients forget or refuse to take their prescribed oral medications, weeks or months may go by before they experience an exacerbation; the effects of nonadherence become apparent too late to preempt the problem. On the other hand, if a patient fails to show up for an injection, the problem of nonadherence can be immediately addressed. When injectable medication is combined with an active psychosocial treatment program that will respond assertively to nonadherence, relapse rates may be reduced. By preventing or delaying relapse, consistent treatment can improve the patient's quality of life and lead to an overall reduction in the cost of care.
自20世纪60年代初长效长效抗精神病药物被引入临床实践以来，它们已被广泛用作精神分裂症患者的维持治疗药物。注射用长效抗精神病治疗药物改善的药代动力学特性提供了更可靠的药物递送，并减少了药物血浆峰浓度和谷浓度的差异。比较短效口服抗精神病药物和长效注射用抗精神病药物的研究虽然并不完美，但支持注射用抗精神病药物在患者预后方面比口服抗精神病药物具有实际益处，这主要归功于依从性的提高。如果患者忘记或拒绝服用规定的口服药物，可能要过数周或数月才会病情加重；不依从的影响显现得太晚，无法预先防止问题发生。另一方面，如果患者未前来注射，不依从问题可立即得到解决。当注射用药物与积极的社会心理治疗方案相结合，该方案能对不依从行为做出果断反应时，复发率可能会降低。通过预防或延迟复发，持续治疗可改善患者的生活质量，并导致护理成本总体降低。
