Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue, NW, Washington, DC 20037, USA.
J Clin Psychopharmacol. 2011 Feb;31(1):10-5. doi: 10.1097/JCP.0b013e3182042154.
Little is known about determinants of second-generation antipsychotic dosages during initial hospitalization of first-episode psychosis. This study examined potential predictors of dosage of an atypical antipsychotic agent, risperidone, at hospital discharge after initial evaluation and treatment of first-episode nonaffective psychosis in 3 naturalistic, public-sector treatment settings.
The number of psychotropic agents prescribed and discharge antipsychotic dosage were abstracted from the medical record. Demographic and extensive clinical characteristics were assessed through a clinical research study conducted at the 3 sites. One-way analyses of variance, trend tests using specific linear combinations of estimates, and χ² tests assessed for associations between atypical antipsychotic dosage and 5 hypothesized predictors, as well as 12 exploratory variables.
Among 155 hospitalized first-episode patients, 121 (78.1%) were discharged on risperidone, and subsequent analyses focused on that subset. The mean risperidone dosage among those 121 patients was 4.26 mg; 31 received 1 to 2 mg, 45 received 3 to 4 mg, 37 received 5 to 6 mg, and 8 received more than 6 mg. Analyses suggested that older age at hospitalization, the number of psychotropic agents prescribed, excited symptoms, and premorbid social functioning may be predictors of the discharge dosage.
Although several factors emerged, in general, predictors of discharge dosages of second-generation agents, here exemplified by risperidone, in real-world practice settings remain to be clarified. Given the importance of antipsychotic initiation during first hospitalization, future research should test an even broader array of potential predictors.
对于首发精神病患者住院初期第二代抗精神病药物的剂量，我们知之甚少。本研究在三个自然的公共卫生机构中，对首发非情感性精神病患者初始评估和治疗后，在出院时评估和比较了不同潜在预测因子与一种新型抗精神病药物（利培酮）剂量的关系。
从病历中提取出所开精神科药物的种类和出院时的抗精神病药物剂量。通过在这三个地点进行的临床研究评估了人口统计学和广泛的临床特征。采用单因素方差分析、特定估计值线性组合的趋势检验以及卡方检验，评估新型抗精神病药物剂量与五个假设预测因子以及十二个探索性变量之间的关系。
在 155 名住院首发患者中，121 名（78.1%）出院时使用利培酮，随后的分析集中在该亚组。121 名患者的平均利培酮剂量为 4.26mg；31 人服用 1-2mg，45 人服用 3-4mg，37 人服用 5-6mg，8 人服用超过 6mg。分析表明，住院时年龄较大、所用精神科药物的种类较多、兴奋症状和病前社会功能可能是出院剂量的预测因子。
尽管出现了一些因素，但在一般情况下，第二代药物（此处以利培酮为例）的出院剂量的预测因子仍需进一步阐明。鉴于在首次住院期间启动抗精神病药物治疗的重要性，未来的研究应进一步测试更广泛的潜在预测因子。
