Glick Ira D, Pham Diana, Davis John M
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
J Clin Psychiatry. 2006 Aug;67(8):1261-5. doi: 10.4088/jcp.v67n0813.
There are virtually no controlled data suggesting that concomitant psychotropic medications (CPMs) improve outcome in schizophrenia after the acute phase. Despite that, polypharmacy (with all of its disadvantages) is far more common than monotherapy. To our knowledge, there have been no published reports of prospective systematic investigations of the efficacy of unrestricted CPM use in nonacute schizophrenia.
This was a naturalistic, systematic study using a sample of 53 stabilized patients with DSM-IV-TR schizophrenia from 1 clinical practice setting including both private patients and patients from controlled research studies of the effectiveness of antipsychotics. Since there are meager controlled or systematic data on the effectiveness of CPM use with antipsychotics in nonacute schizophrenia, we tested the clinical strategy of CPM use by gradually tapering all CPMs (except antianxiety agents). The aim was to determine if the CPM improved outcome, had no effect, or worsened outcome using the Clinical Global Impressions-Improvement scale before and after taper, over at least 3 months and in some cases up to 18 months after discontinuation. Data were gathered from July 2002 to June 2005.
For 21 patients undergoing 22 antidepressant tapers, no change was noted in 18 of 22 tapers, while in 3 improvement was noted and in 1 worsening was noted. For the 12 patients on treatment with mood stabilizers, no change was noted in 10 of 13 discontinuations, while in 3 mild worsening was noted. One patient was on treatment with both modafinil and trazodone and reported no change after tapering each in separate discontinuation trials, while another 3 patients were taking sleeping medications and also noted no change after discontinuation.
For most stabilized, chronic patients with schizophrenia, tapering adjunctive medications did not change outcome. This naturalistic study further defines the limits of efficacy of some concomitant classes of medications in patients with chronic schizophrenia who are already receiving adequate antipsychotic therapy.
几乎没有对照数据表明，在急性期过后，联用精神药物（CPMs）能改善精神分裂症的预后。尽管如此，联合用药（尽管有其所有缺点）远比单一疗法更为常见。据我们所知，尚无关于在非急性期精神分裂症中不受限制地使用CPMs疗效的前瞻性系统研究报告。
这是一项自然主义的系统研究，样本来自1个临床实践机构的53例病情稳定的DSM-IV-TR精神分裂症患者，包括私人患者以及抗精神病药物有效性对照研究中的患者。由于关于在非急性期精神分裂症中使用CPMs联合抗精神病药物的有效性的对照或系统数据很少，我们通过逐渐减少所有CPMs（抗焦虑药物除外）来测试CPMs的临床使用策略。目的是使用临床总体印象改善量表，在逐渐减少用药前和用药后至少3个月、在某些情况下停药后长达18个月，确定CPMs是改善了预后、没有效果还是恶化了预后。数据收集时间为2002年7月至2005年6月。
对于21例接受22次抗抑郁药减量的患者，22次减量中有18次未观察到变化，3次观察到改善，1次观察到恶化。对于12例接受心境稳定剂治疗的患者，13次停药中有10次未观察到变化，3次观察到轻度恶化。1例患者同时服用莫达非尼和曲唑酮，在单独的停药试验中每次减量后均报告无变化，另外3例患者服用助眠药物，停药后也未观察到变化。
对于大多数病情稳定的慢性精神分裂症患者，逐渐减少辅助用药并未改变预后。这项自然主义研究进一步明确了在已经接受充分抗精神病治疗的慢性精神分裂症患者中，某些联用药物类别的疗效限度。
