Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland.
Am J Psychiatry. 2011 Jun;168(6):603-9. doi: 10.1176/appi.ajp.2011.10081224. Epub 2011 Mar 1.
Data on the effectiveness of antipsychotics in the early phase of schizophrenia are limited. The authors examined the risk of rehospitalization and drug discontinuation in a nationwide cohort of 2,588 consecutive patients hospitalized for the first time with a diagnosis of schizophrenia between 2000 and 2007 in Finland.
The authors linked national databases of hospitalization, mortality, and antipsychotic prescriptions and computed hazard ratios, adjusting for the effects of sociodemographic and clinical variables, the temporal sequence of the antipsychotics used, and the choice of the initial antipsychotic for each patient.
Of 2,588 patients, 1,507 (58.2%) collected a prescription for an antipsychotic during the first 30 days after hospital discharge, and 1,182 (45.7%, 95% confidence interval [CI]=43.7-47.6) continued their initial treatment for 30 days or longer. In a pairwise comparison between depot injections and their equivalent oral formulations, the risk of rehospitalization for patients receiving depot medications was about one-third of that for patients receiving oral medications (adjusted hazard ratio=0.36, 95% CI=0.17-0.75). Compared with oral risperidone, clozapine (adjusted hazard ratio=0.48, 95% CI=0.31-0.76) and olanzapine (adjusted hazard ratio=0.54, 95% CI=0.40-0.73) were each associated with a significantly lower rehospitalization risk. Use of any antipsychotic compared with no antipsychotic was associated with lower mortality (adjusted hazard ratio=0.45, 95% CI=0.31-0.67).
In Finland, only a minority of patients adhere to their initial antipsychotic during the first 60 days after discharge from their first hospitalization for schizophrenia. Use of depot antipsychotics was associated with a significantly lower risk of rehospitalization than use of oral formulations of the same compounds. Among oral antipsychotics, clozapine and olanzapine were associated with more favorable outcomes. Use of any antipsychotic was associated with lower mortality.
抗精神病药在精神分裂症早期阶段的疗效数据有限。作者在芬兰对 2000 年至 2007 年间首次因精神分裂症住院的 2588 例连续患者进行了全国性队列研究，调查了重新住院和药物停药的风险。
作者将住院、死亡率和抗精神病药处方的国家数据库进行了关联，并计算了风险比，调整了社会人口统计学和临床变量、所使用抗精神病药的时间顺序以及每位患者初始抗精神病药的选择的影响。
在 2588 例患者中，有 1507 例（58.2%）在出院后 30 天内开出了抗精神病药处方，有 1182 例（45.7%，95%置信区间[CI]=43.7-47.6）继续接受初始治疗 30 天或更长时间。在比较长效注射剂和其等效的口服制剂时，接受长效药物治疗的患者重新住院的风险约为接受口服药物治疗的患者的三分之一（调整后的风险比=0.36，95%CI=0.17-0.75）。与口服利培酮相比，氯氮平（调整后的风险比=0.48，95%CI=0.31-0.76）和奥氮平（调整后的风险比=0.54，95%CI=0.40-0.73）的重新住院风险均显著降低。与未使用任何抗精神病药相比，使用任何抗精神病药与死亡率降低相关（调整后的风险比=0.45，95%CI=0.31-0.67）。
在芬兰，只有少数患者在首次因精神分裂症住院后 60 天内坚持使用初始抗精神病药。长效抗精神病药的使用与重新住院的风险显著降低相关，而相同化合物的口服制剂则没有这种相关性。在口服抗精神病药中，氯氮平和奥氮平的结果更有利。使用任何抗精神病药都与死亡率降低相关。
