Department of Psychiatry and Psychotherapy, Heinrich-Heine-University Düsseldorf, Rhineland State Clinics Düsseldorf, Germany.
Eur Neuropsychopharmacol. 2010 May;20(5):310-6. doi: 10.1016/j.euroneuro.2010.02.001. Epub 2010 Mar 3.
Effectiveness has become more and more important as a comprehensive outcome measure for (long-term) treatment in schizophrenia. Early predictors to identify patients at a high risk for not succeeding the initiated treatment would be very useful. Discontinuation of the initiated treatment was used as criterion for effectiveness and patients' drug attitude was shown to be predictive for non-adherence or discontinuation of long-term treatment in schizophrenia. Accordingly, the predictive validity of the Drug Attitude Inventory (DAI) for effectiveness should be evaluated. Based on a sub-sample of patients from the EUFEST study for whom DAI assessments were available significant predictors for effectiveness as measured by discontinuation of initiated treatment were identified based on a logistic and a Cox-regression analysis. A Receiver-Operating Characteristic- (ROC-) analysis was conducted for the DAI, prognostic / diagnostic parameters (sensitivity, specificity) were calculated and a cut-off value suggested. In a sample of 228 first-episode patients, the DAI score was the most powerful predictor for effectiveness (p<0.001) besides two other significant predictors (PANSS-positive score and sexual side effects). The ROC-analysis revealed an area under the curve of 0.64 (p<0.001). The suggested cut-off point of about 20 yielded a sensitivity of 70-75% and a specificity of 40-45%. Study results indicate that the Drug Attitude Inventory, filled in by patients early in treatment seems to be a valid predictor for effectiveness as measured by discontinuation of the initiated treatment. DAI scores could also serve as an (differential) indicator for the need of enhanced treatment monitoring. These findings have to be validated in other (first-episode) samples.
随着（长期）精神分裂症治疗的综合结果测量，有效性变得越来越重要。识别出开始治疗后效果不佳的高风险患者的早期预测指标将非常有用。以停止初始治疗作为有效性的标准，并且患者的药物态度被证明可以预测精神分裂症的长期治疗不依从或停药。因此，应该评估药物态度量表（DAI）对有效性的预测效度。基于 Eufest 研究的亚样本患者，他们可提供 DAI 评估，使用逻辑回归和 Cox 回归分析，根据停药作为有效性的衡量标准，确定了有效性的显著预测因子。对 DAI 进行了受试者工作特征（ROC）分析，计算了预后/诊断参数（敏感性、特异性），并提出了一个截断值。在 228 名首发患者的样本中，DAI 评分是除了另外两个显著预测因子（阳性症状群 PANSS 评分和性功能障碍）之外，对有效性的最强预测因子（p<0.001）。ROC 分析显示曲线下面积为 0.64（p<0.001）。建议的截断点约为 20，灵敏度为 70-75%，特异性为 40-45%。研究结果表明，在治疗早期由患者填写的药物态度量表似乎是衡量停药的有效性的有效预测因子。DAI 评分也可以作为需要加强治疗监测的（差异）指标。这些发现需要在其他（首发）样本中进行验证。
