Centre for Addiction and Mental Health, Geriatric Mental Health Program and Multimodal Imaging Group, and Department of Psychiatry, University of Toronto, Ontario, Canada, and Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, Japan.
Br J Psychiatry. 2011 Oct;199(4):275-80. doi: 10.1192/bjp.bp.110.083907.
Improvements are greatest in the earlier weeks of antipsychotic treatment of patients with non-resistant schizophrenia.
To address the early time-line for improvement with antipsychotics in treatment-resistant schizophrenia.
Randomised double-blind trials of antipsychotic medication in adult patients with treatment-resistant schizophrenia were investigated (last search June 2010). A series of metaregression analyses were carried out to examine the effect of time on the average item scores in the Positive and Negative Syndrome Scale (PANSS) or Brief Psychiatric Rating Scale (BPRS) at three or more distinct time points within the first 6 weeks of treatment.
Study duration varied from 4 weeks to 1 year and the definitions of treatment resistance as well as of treatment response were not necessarily consistent across 19 identified studies, resulting in highly variable rates of response (0–76%).The mean standardised baseline item score in the PANSS or BPRS was 3.4 (s.e. = 0.06) in the five studies included in the meta-regression analysis, with the average baseline Clinical Global Impression – Severity score being 5.2 (marked illness). For the pooled population treated with a range of antipsychotics (n = 1019), significant reductions in the mean item scores occurred during the first 4 weeks; improvements observed in later weeks were smaller and non-significant. In contrast, weekly improvement with clozapine was significant throughout (n = 356).
Our findings provide preliminary evidence that the majority of improvement with antipsychotics may occur relatively early.More consistent improvements with clozapine may be associated with a gradual titration. To further elucidate response patterns, future studies are needed to provide data over regular intervals during earlier stages of treatment.
在非耐药精神分裂症患者的抗精神病药物治疗的早期几周内，改善最为明显。
探讨治疗抵抗性精神分裂症患者抗精神病药物治疗早期改善的时间线。
对成年治疗抵抗性精神分裂症患者的抗精神病药物随机双盲试验进行了研究（最后一次检索时间为 2010 年 6 月）。对前 6 周内至少 3 个不同时间点的阳性和阴性综合征量表（PANSS）或简明精神病评定量表（BPRS）的平均项目评分进行了一系列荟萃回归分析，以评估时间对其的影响。
研究持续时间从 4 周到 1 年不等，治疗抵抗的定义以及治疗反应的定义在 19 项确定的研究中并不一定一致，导致反应率（0-76%）高度可变。荟萃回归分析中包含的 5 项研究中，PANSS 或 BPRS 的平均标准基线项目评分为 3.4（s.e. = 0.06），平均基线临床总体印象-严重程度评分为 5.2（严重疾病）。对于接受各种抗精神病药物治疗的人群（n = 1019），在第 1 至 4 周期间，平均项目评分显著下降；在随后的几周中观察到的改善较小且无统计学意义。相比之下，氯氮平每周的改善均有显著意义（n = 356）。
我们的研究结果初步表明，大多数抗精神病药物治疗的改善可能发生在相对较早的阶段。氯氮平更一致的改善可能与逐渐滴定有关。为了进一步阐明反应模式，需要进一步的研究在治疗的早期阶段提供更规律的间隔数据。
