Peuskens J, Gillain B, De Graeve D, Van Vleymen B, Albert A
Universitair Psychiatrisch Centrum Katholieke Universiteit Leuven, Campus St. Jozef Kortenberg, Leuvensesteenweg 517, 3070 Kortenberg, Belgium.
Eur Psychiatry. 2009 Apr;24(3):154-63. doi: 10.1016/j.eurpsy.2008.11.002. Epub 2008 Dec 31.
This Schizophrenia Outcome Survey compared medical costs, psychopathology and adverse events in outpatients for 2 years following hospitalisation for an acute schizophrenic episode.
Adults stabilised with haloperidol, olanzapine or risperidone entered this observational study <or=1 month after discharge and were assessed at baseline, 3, 6, 12, 18 and 24 months using Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI), Global Assessment of Functioning and adverse events reporting.
Among 323 patients (haloperidol 32, olanzapine 149, risperidone 142), baseline characteristics were similar in the olanzapine and risperidone groups, except for more first episodes in the risperidone group (p=0.01). Haloperidol patients were more often single and institutionalised, less educated, had more residual schizophrenia, were longer hospitalised in the previous year, took more corrective and psychotropic drugs and had more extrapyramidal symptoms (EPS) and gynaecomastia (all significantly). Sixty-eight percent of patients completed a 2-year follow-up. In all groups, CGI and GAF improved during the first 3 months (both p<0.0001) while BPRS deteriorated in the first year (all within group changes p<0.05, between group changes NS) before it stabilised. There were no significant differences in hospitalisations and no change in social profile. At the last visit, 66% of haloperidol (p<0.01), 35% of olanzapine (NS) and 39% (NS) of risperidone patients had >or=1 EPS; 69% (p<0.013), 40 and 44%, respectively, had >or=1 sexual problem (NS). Mean weight gain was 0.4 (NS), 2.6 (p<0.05) and 2.6 kg (p<0.05), respectively.
In this naturalistic study, treatment allocation might have introduced a bias in the interpretation of efficiency results, but olanzapine and risperidone caused less EPS than haloperidol during 2 years of outpatient follow-up.
本精神分裂症结局调查比较了急性精神分裂症发作住院后2年门诊患者的医疗费用、精神病理学及不良事件。
使用氟哌啶醇、奥氮平或利培酮病情稳定的成人患者在出院后≤1个月进入本观察性研究，并在基线、3、6、12、18和24个月时使用简明精神病评定量表（BPRS）、临床总体印象量表（CGI）、功能总体评定量表及不良事件报告进行评估。
在323例患者中（氟哌啶醇组32例，奥氮平组149例，利培酮组142例），奥氮平组和利培酮组的基线特征相似，但利培酮组首发发作更多（p = 0.01）。氟哌啶醇组患者单身及住院治疗的情况更多，受教育程度更低，残留型精神分裂症更多，前一年住院时间更长，服用更多的纠正药物和精神药物，且锥体外系症状（EPS）和男性乳房发育更多（均有显著差异）。68%的患者完成了2年随访。在所有组中，CGI和GAF在前3个月有所改善（均p < 0.0001），而BPRS在第一年恶化（所有组内变化p < 0.05，组间变化无显著性差异），之后趋于稳定。住院情况无显著差异，社会状况无变化。在最后一次访视时，氟哌啶醇组66%（p < 0.01）、奥氮平组35%（无显著性差异）、利培酮组39%（无显著性差异）的患者有≥1次EPS；分别有69%（p < 0.013）、40%和44%的患者有≥1次性问题（无显著性差异）。平均体重增加分别为0.4 kg（无显著性差异）、2.6 kg（p < 0.05）和2.6 kg（p < 0.05）。
在本自然主义研究中，治疗分配可能在疗效结果的解释中引入了偏差，但在2年门诊随访期间，奥氮平和利培酮所致EPS比氟哌啶醇少。
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