Department of Psychiatry, McGill University, Montreal, Canada.
Psychiatry Res. 2012 Mar 30;196(1):45-51. doi: 10.1016/j.psychres.2011.10.015. Epub 2012 Feb 28.
Adequate adherence to medication confers benefits on patients with psychotic illness, but is difficult to achieve. Efficacy of medication influences adherence in patients in advanced phases of illness and may have a similar influence on patients with a first episode of psychosis (FEP). We assessed medication adherence and efficacy in 216 FEP patients at program entry and at 3 and 6 months later. "Efficacy" was evaluated as the ability of medication to reduce positive or negative symptoms to below established thresholds for clinical remission at each evaluation. Adherence was defined as adequate (>75%) or not. Resolution of negative symptoms by month 3 of treatment was associated with inadequate adherence at months 3 and 6. In contrast, rapid resolution of positive symptoms showed no relationship to adherence. In a multivariate analysis taking into account other determinants of adherence in FEP, the role of early negative symptom remission was confirmed, and we found that a 3-month sustained remission of positive symptoms was associated with adequate adherence. Medication efficacy may promote adherence if it produces sustained remission of positive symptoms. However, many patients who benefit from medication, particularly those with rapid improvement of negative symptoms, fail to adhere to the treatment.
适当的药物依从性可使精神病患者受益，但难以实现。药物疗效影响疾病晚期患者的依从性，也可能对首发精神病（FEP）患者有类似影响。我们在项目开始时以及 3 个月和 6 个月后评估了 216 名 FEP 患者的药物依从性和疗效。“疗效”评估为药物降低阳性或阴性症状的能力，使其在每次评估时低于临床缓解的既定阈值。依从性定义为充足（>75%）或不足。治疗 3 个月时阴性症状的缓解与 3 个月和 6 个月时的依从性不足有关。相比之下，阳性症状的快速缓解与依从性无关。在考虑 FEP 中其他依从性决定因素的多变量分析中，早期阴性症状缓解的作用得到了证实，我们发现阳性症状持续 3 个月缓解与依从性充足有关。如果药物疗效能产生阳性症状的持续缓解，可能会促进患者的依从性。然而，许多受益于药物治疗的患者，尤其是那些阴性症状迅速改善的患者，未能坚持治疗。
