Guo Xiaofeng, Zhai Jinguo, Liu Zhening, Fang Maosheng, Wang Bo, Wang Chuanyue, Hu Bin, Sun Xueli, Lv Luxian, Lu Zheng, Ma Cui, He Xiaolin, Guo Tiansheng, Xie Shiping, Wu Renrong, Xue Zhimin, Chen Jindong, Twamley Elizabeth W, Jin Hua, Zhao Jingping
Mental Health Institute, Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
Arch Gen Psychiatry. 2010 Sep;67(9):895-904. doi: 10.1001/archgenpsychiatry.2010.105.
Antipsychotic drugs are limited in their ability to improve the overall outcome of schizophrenia. Adding psychosocial treatment may produce greater improvement in functional outcome than does medication treatment alone.
To evaluate the effectiveness of antipsychotic medication alone vs combined with psychosocial intervention on outcomes of early-stage schizophrenia.
Randomized controlled trial.
Ten clinical sites in China.
Clinical sample of 1268 patients with early-stage schizophrenia treated from January 1, 2005, through October 31, 2007. Intervention Patients were randomly assigned to receive antipsychotic medication treatment only or antipsychotic medication plus 12 months of psychosocial intervention consisting of psychoeducation, family intervention, skills training, and cognitive behavior therapy administered during 48 group sessions.
The rate of treatment discontinuation or change due to any cause, relapse or remission, and assessments of insight, treatment adherence, quality of life, and social functioning.
The rates of treatment discontinuation or change due to any cause were 32.8% in the combined treatment group and 46.8% in the medication-alone group. Comparisons with medication treatment alone showed lower risk of any-cause discontinuation with combined treatment (hazard ratio, 0.62; 95% confidence interval, 0.52-0.74; P < .001) and lower risk of relapse with combined treatment (0.57; 0.44-0.74; P < .001). The combined treatment group exhibited greater improvement in insight (P < .001), social functioning (P = .002), activities of daily living (P < .001), and 4 domains of quality of life as measured by the Medical Outcomes Study 36-Item Short Form Health Survey (all P < or = .02). Furthermore, a significantly higher proportion of patients receiving combined treatment obtained employment or accessed education (P = .001).
Compared with those receiving medication only, patients with early-stage schizophrenia receiving medication and psychosocial intervention have a lower rate of treatment discontinuation or change, a lower risk of relapse, and improved insight, quality of life, and social functioning.
clinicaltrials.gov Identifier: NCT00654576.
抗精神病药物在改善精神分裂症整体预后方面的能力有限。添加心理社会治疗可能比单纯药物治疗在功能预后方面产生更大的改善。
评估单纯抗精神病药物治疗与联合心理社会干预对早期精神分裂症预后的有效性。
随机对照试验。
中国的10个临床站点。
2005年1月1日至2007年10月31日期间接受治疗的1268例早期精神分裂症患者的临床样本。干预措施：患者被随机分配接受单纯抗精神病药物治疗或抗精神病药物加12个月的心理社会干预，心理社会干预包括心理教育、家庭干预、技能培训和在48次小组会议期间实施的认知行为疗法。
因任何原因导致的治疗中断或改变率、复发或缓解情况，以及洞察力、治疗依从性、生活质量和社会功能的评估。
联合治疗组因任何原因导致的治疗中断或改变率为32.8%，单纯药物治疗组为46.8%。与单纯药物治疗相比，联合治疗导致任何原因中断治疗的风险更低（风险比，0.62；95%置信区间，0.52 - 0.74；P <.001），联合治疗复发风险更低（0.57；0.44 - 0.74；P <.001）。联合治疗组在洞察力（P <.001）、社会功能（P =.002）、日常生活活动（P <.001）以及通过医学结局研究36项简短健康调查测量的生活质量的4个领域方面均有更大改善（所有P <或 =.02）。此外，接受联合治疗的患者获得就业或接受教育的比例显著更高（P =.001）。
与仅接受药物治疗的患者相比，接受药物和心理社会干预的早期精神分裂症患者治疗中断或改变率更低，复发风险更低，且洞察力、生活质量和社会功能得到改善。
clinicaltrials.gov标识符：NCT00654576。
