抗精神病药物治疗精神分裂症时第一代和第二代药物的停药时间。
Time to discontinuation of first- and second-generation antipsychotic medications in the treatment of schizophrenia.
机构信息
VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), 10 N. Greene St. (BT/MIRECC), Baltimore, MD 21201, USA.
出版信息
Schizophr Res. 2011 Sep;131(1-3):127-32. doi: 10.1016/j.schres.2011.04.028. Epub 2011 May 14.
BACKGROUND
Continuous adherence to antipsychotic treatment is critical for individuals with schizophrenia to benefit optimally, yet studies have shown rates of antipsychotic discontinuation to be high with few differences across medications. We investigated discontinuation of selected first- and second-generation antipsychotics among individuals with schizophrenia receiving usual care in a VA healthcare network in the U.S. mid-Atlantic region.
METHODS
We identified 2138 VA patients with schizophrenia who initiated antipsychotic treatment with one of five non-clozapine second-generation antipsychotics or either of the two most commonly prescribed first-generation agents between 1/2004 and 9/2006. The dependent variable was duration of continuous antipsychotic possession from the index prescription until the first gap of more than 45 days between prescriptions. We used the Cox proportional hazards model to compare the hazard of discontinuation among the seven antipsychotics controlling for patient demographic and clinical characteristics. The reference group was olanzapine.
RESULTS
The majority of patients (84%) discontinued their index antipsychotic during the follow-up period (up to 33 months). In multivariable analysis, only risperidone had a significantly greater hazard of discontinuation compared to olanzapine (Adjusted hazard ratio=1.15, 95% CI: 1.02-1.30, p=.025). Younger age, non-white race, homelessness, substance use disorder, recent inpatient mental health hospitalization, and prescription of another antipsychotic were also associated with earlier discontinuation.
CONCLUSIONS
Examination of a usual care sample of individuals with schizophrenia revealed short durations of antipsychotic use, with only risperidone having a shorter time to discontinuation than olanzapine. These findings demonstrate that current antipsychotic agents have limited overall acceptability by patients in usual care.
背景
对于精神分裂症患者来说，持续坚持抗精神病药物治疗至关重要，才能使其最大程度受益，但研究表明，抗精神病药物停药率很高，且不同药物之间差异不大。我们在美国中大西洋地区的退伍军人医疗保健网络中，对接受常规护理的精神分裂症患者中，一些选定的第一代和第二代抗精神病药物的停药情况进行了调查。
方法
我们确定了 2138 名在 2004 年 1 月至 2006 年 9 月期间开始使用五种非氯氮平第二代抗精神病药物或两种最常开处方的第一代药物之一治疗的退伍军人事务部精神分裂症患者。因变量是从起始处方到两次处方之间间隔超过 45 天的首次间断之间，连续使用抗精神病药物的持续时间。我们使用 Cox 比例风险模型，在控制患者人口统计学和临床特征的情况下，比较七种抗精神病药物的停药风险。奥氮平为参考组。
结果
大多数患者（84％）在随访期间（最长 33 个月）停止使用其起始抗精神病药物。在多变量分析中，只有利培酮与奥氮平相比，停药的风险显著更高（调整后的风险比=1.15，95％CI：1.02-1.30，p=.025）。年龄较小、非白种人、无家可归、物质使用障碍、近期住院心理健康治疗和另一种抗精神病药物的处方也与更早的停药有关。
结论
对接受常规护理的精神分裂症患者样本的检查显示，抗精神病药物的使用时间很短，只有利培酮的停药时间短于奥氮平。这些发现表明，目前的抗精神病药物在常规护理中总体上不被患者接受。
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