Fujikawa Midori, Togo Takashi, Yoshimi Asuka, Fujita Junichi, Nomoto Munetaka, Kamijo Atsushi, Amagai Toru, Uchikado Hirotake, Katsuse Omi, Hosojima Hideki, Sakura Yoshihisa, Furusho Ryo, Suda Akira, Yamaguchi Takayuki, Hori Taketo, Kamada Ayuko, Kondo Taizo, Ito Michitomo, Odawara Toshinari, Hirayasu Yoshio
Department of Psychiatry, Yokohama City University, 3-9 Fukuura, Kanazawa-ku Yokohama 236-0004, Japan.
Prog Neuropsychopharmacol Biol Psychiatry. 2008 Apr 1;32(3):755-60. doi: 10.1016/j.pnpbp.2007.12.002. Epub 2007 Dec 14.
Adherence to antipsychotic treatment is particularly important in the long-term management of schizophrenia and other related psychotic disorders since poor adherence to medication is associated with poor health outcomes. Although the patients' subjective satisfaction with the medication is crucial for adherence to medication, few studies have examined the relationship between subjective satisfaction with antipsychotics and adherence. In this study, we investigated subjective satisfaction with antipsychotics in patients with schizophrenia by using the Treatment Satisfaction Questionnaire for Medication (TSQM), a self-reporting instrument to assess the major dimensions of patients' satisfaction with their medication. The subjects included 121 clinically stabilized outpatients who met the following criteria: 1) patients between 20 and 65 years of age, diagnosed with schizophrenia or other psychotic disorders as defined by DSM-IV, 2) patients undergoing oral antipsychotic monotherapy or taking only an antiparkinsonian agent as an adjuvant remedy, and 3) patients who had received a stable dose of an antipsychotic for more than four weeks. Patients were asked to answer the TSQM questions, and their clinical symptoms were also evaluated by the Brief Psychiatric Rating Scale (BPRS). Satisfaction with regard to side-effects (p=0.015) and global satisfaction (p=0.035) were significantly higher in patients taking second-generation antipsychotics (SGAs, n=111) than those taking first-generation antipsychotics (FGAs, n=10), whereas no significant difference was found between the two groups in clinical symptoms according to BPRS (p=0.637) or the Drug-induced Extrapyramidal Symptoms Scale (DIEPSS, p=0.209). In addition, correlations were not significant between the subjective satisfactions and clinician-rated objective measures of the symptoms. These findings suggest that SGAs have more favorable subjective satisfaction profiles than FGAs in the treatment of schizophrenia. Since it is often difficult to detect the difference by a traditional objective assessment of the patients, it is desirable that physicians pay attention to the patients' subjective satisfaction in conjunction with their own objective clinical assessment.
坚持抗精神病药物治疗在精神分裂症及其他相关精神障碍的长期管理中尤为重要,因为药物依从性差与健康状况不佳有关。尽管患者对药物的主观满意度对坚持服药至关重要,但很少有研究探讨对抗精神病药物的主观满意度与依从性之间的关系。在本研究中,我们使用药物治疗满意度问卷(TSQM)对精神分裂症患者对抗精神病药物的主观满意度进行了调查,TSQM是一种自我报告工具,用于评估患者对其药物治疗满意度的主要维度。研究对象包括121名临床症状稳定的门诊患者,他们符合以下标准:1)年龄在20至65岁之间,根据《精神疾病诊断与统计手册》第四版(DSM-IV)诊断为精神分裂症或其他精神障碍;2)正在接受口服抗精神病药物单一疗法或仅服用抗帕金森药物作为辅助治疗;3)接受稳定剂量抗精神病药物治疗超过四周。患者被要求回答TSQM问题,同时还通过简明精神病评定量表(BPRS)对其临床症状进行评估。服用第二代抗精神病药物(SGA,n = 111)的患者在副作用满意度(p = 0.015)和总体满意度(p = 0.035)方面显著高于服用第一代抗精神病药物(FGA,n = 10)的患者,而根据BPRS(p = 0.637)或药物性锥体外系症状量表(DIEPSS,p = 0.209)评估,两组患者的临床症状无显著差异。此外,主观满意度与临床医生评定的症状客观指标之间的相关性不显著。这些发现表明,在精神分裂症治疗中,第二代抗精神病药物比第一代抗精神病药物具有更有利的主观满意度特征。由于通过传统的客观评估往往难以发现差异,因此医生在进行客观临床评估的同时,应关注患者的主观满意度。