Alenius Malin, Hammarlund-Udenaes Margareta, Hartvig Per, Sundquist Staffan, Lindström Leif
Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden.
Compr Psychiatry. 2009 Sep-Oct;50(5):453-62. doi: 10.1016/j.comppsych.2008.11.001. Epub 2009 Jan 16.
Various approaches have been made over the years to classify psychotic patients according to inadequate treatment response, using terms such as treatment resistant or treatment refractory. Existing classifications have been criticized for overestimating positive symptoms; underestimating residual symptoms, negative symptoms, and side effects; or being to open for individual interpretation. The aim of this study was to present and evaluate a new method of classification according to treatment response and, thus, to identify patients in functional remission.
A naturalistic, cross-sectional study was performed using patient interviews and information from patient files. The new classification method CANSEPT, which combines the Camberwell Assessment of Need rating scale, the Udvalg for Kliniske Undersøgelser side effect rating scale (SE), and the patient's previous treatment history (PT), was used to group the patients according to treatment response. CANSEPT was evaluated by comparison of expected and observed results.
In the patient population (n = 123), the patients in functional remission, as defined by CANSEPT, had higher quality of life, fewer hospitalizations, fewer psychotic symptoms, and higher rate of workers than those with the worst treatment outcome.
In the evaluation, CANSEPT showed validity in discriminating the patients of interest and was well tolerated by the patients. CANSEPT could secure inclusion of correct patients in the clinic or in research.
多年来,人们采用了各种方法,使用治疗抵抗或治疗难治等术语,根据治疗反应不足对精神病患者进行分类。现有的分类方法受到批评,原因包括高估阳性症状;低估残留症状、阴性症状和副作用;或者对个体解释过于开放。本研究的目的是提出并评估一种根据治疗反应进行分类的新方法,从而识别功能缓解的患者。
采用自然主义横断面研究,通过患者访谈和患者档案信息进行。新的分类方法CANSEPT结合了坎伯韦尔需求评估量表、临床检查副作用评定量表(SE)和患者既往治疗史(PT),根据治疗反应对患者进行分组。通过比较预期结果和观察结果对CANSEPT进行评估。
在患者群体(n = 123)中,根据CANSEPT定义,功能缓解的患者比治疗效果最差的患者生活质量更高、住院次数更少、精神病症状更少且工作率更高。
在评估中,CANSEPT在区分感兴趣的患者方面显示出有效性,并且患者耐受性良好。CANSEPT可以确保在临床或研究中纳入正确的患者。