Staring A B P, Mulder C L, Duivenvoorden H J, De Haan L, Van der Gaag M
Erasmus University Medical Center, Dr. Molewaterplein 50, 3015 GE Rotterdam, The Netherlands.
Schizophr Res. 2009 Aug;113(1):27-33. doi: 10.1016/j.schres.2009.05.022. Epub 2009 Jun 13.
Non-compliance with medication often has long-term detrimental effects in patients with schizophrenia. However, when patients are compliant, it is not certain whether they experience short-term improved quality of life. By simultaneously reducing symptoms and increasing side-effects, compliance with antipsychotics may have opposing effects on a patient's perceived quality of life.
This study aimed to identify any clinical-empirical evidence for two pathways between compliance and quality of life.
To evaluate various pathways between compliance (Service Engagement Scale plus a one-item rating), psychotic symptoms (Positive and Negative Syndromes Scale), adverse medication effects (Subjective Wellbeing under Neuroleptics scale), and quality of life (EQ-5D), we used Structural Equation Modeling on cross-sectional data of 114 patients with a psychotic disorder.
Compliance was not directly related to quality of life (r=0.004). The best-fitting model (chi(2)=1.08; df=1) indicated that high compliance was associated with fewer psychotic symptoms (beta=-0.23) and more adverse medication effects (beta=0.22). Symptoms (beta=-0.17) and adverse medication effects (beta=-0.48) were both related to lower quality of life.
Our results suggest that compliance with antipsychotics has two opposing pathways towards quality of life, albeit indirect ones. While compliance was associated with less severe psychotic symptoms, and was thus related to higher quality of life, it was also associated with more adverse medication effects, and was thus related to lower quality of life. However, due to our study design, we cannot draw firm conclusions on causality. Two possible clinical implications of the results for compliance and interventions are discussed.
在精神分裂症患者中，不遵医嘱服药往往会产生长期的有害影响。然而，当患者遵医嘱服药时，他们的生活质量在短期内是否会得到改善尚不确定。抗精神病药物在减轻症状的同时也会增加副作用，因此服药依从性对患者感知的生活质量可能会产生相反的影响。
本研究旨在确定服药依从性与生活质量之间两条途径的任何临床实证证据。
为了评估服药依从性（服务参与量表加单项评分）、精神病症状（阳性和阴性症状量表）、药物不良反应（抗精神病药物所致主观幸福感量表）和生活质量（EQ-5D）之间的各种途径，我们对114例精神病患者的横断面数据进行了结构方程模型分析。
服药依从性与生活质量无直接关系（r=0.004）。拟合度最佳的模型（卡方=1.08；自由度=1）表明，高依从性与较少的精神病症状（β=-0.23）和较多的药物不良反应（β=0.22）相关。症状（β=-0.17）和药物不良反应（β=-0.48）均与较低的生活质量相关。
我们的结果表明，抗精神病药物的依从性对生活质量有两条相反的途径，尽管是间接的。虽然依从性与较轻的精神病症状相关，因此与较高的生活质量相关，但它也与较多的药物不良反应相关，因此与较低的生活质量相关。然而，由于我们的研究设计，我们不能就因果关系得出确凿的结论。文中讨论了研究结果对依从性和干预措施的两个可能的临床意义。
