Service de Psychiatrie Adulte, Cliniques Universitaires St Luc, Bruxelles, Belgium.
Early Interv Psychiatry. 2014 Feb;8(1):39-49. doi: 10.1111/eip.12017. Epub 2013 Jan 24.
Potential differences in psychiatric clinical outcomes and hospitalization rates before and after the initiation of long-acting risperidone among recently and long-term diagnosed schizophrenia patients were studied.
Data from two observational studies (Trial for the Initiation and Maintenance Of REmission in Schizophrenia with risperidone (TIMORES) and electronic Schizophrenia Treatment Adherence Registry (e-STAR)) were categorized by the recency of their diagnose and compared in several post hoc analyses. Clinical Global Impression of illness Severity (CGI-S) and Global Assessment of Functioning (GAF) scores, as well as symptoms of clinical deterioration (including hospitalization data) at baseline, 12-month (for TIMORES and e-STAR) and 24-month (for e-STAR) follow-up were analysed. Other outcome measures included discontinuation rate, employment status and remission attainment.
Statistically significantly differences between recent and long-term diagnosed schizophrenic patients at 12- and 24-month follow-up were found for CGI-S (between P < 0.01 and P ≤ 0.001) and GAF (P < 0.05) scores. Other differences between both schizophrenic patient groups were found for measures of clinical deterioration, employment status and full symptomatic remission rates at 1 year. Although no consistent difference was found between recent and long-term patient groups for hospitalization parameters, the difference in length of full hospitalization days was statistically significantly different (P < 0.01) between e-STAR 'Early' and 'Late' patient groups at both 12- and 24-month endpoints: the mean change from baseline was significantly greater for e-STAR 'Early' at 12 months, but greater for e-STAR 'Late' at 24 months.
The findings of the post hoc analyses support the significance of pharmacological interventions, such as long-acting risperidone, in addressing discontinuity issues, especially in recently diagnosed patients.
研究近期和长期诊断为精神分裂症患者在开始长效利培酮前后的精神科临床结局和住院率的潜在差异。
根据诊断时间的长短,将两项观察性研究(TIMORES:用利培酮治疗精神分裂症的缓解和维持试验和电子精神分裂症治疗依从性登记处(e-STAR))的数据进行分类,并在几项事后分析中进行比较。在基线、12 个月(对 TIMORES 和 e-STAR)和 24 个月(对 e-STAR)随访时分析疾病严重程度的临床总体印象量表(CGI-S)和总体功能评估(GAF)评分,以及临床恶化症状(包括住院数据)。其他结果指标包括停药率、就业状况和缓解率。
在 12 个月和 24 个月的随访中,近期和长期诊断的精神分裂症患者在 CGI-S(P < 0.01 和 P ≤ 0.001)和 GAF(P < 0.05)评分方面存在统计学显著差异。在临床恶化指标、就业状况和 1 年时的完全症状缓解率方面,还发现了两组精神分裂症患者之间的其他差异。尽管在住院参数方面,近期和长期患者组之间没有发现一致的差异,但在 e-STAR 的“早期”和“晚期”患者组中,全住院天数的差异在统计学上有显著差异(P < 0.01):与基线相比,e-STAR 的“早期”患者在 12 个月时的变化明显更大,但 e-STAR 的“晚期”患者在 24 个月时的变化更大。
事后分析的结果支持长效利培酮等药物干预措施在解决连续性问题方面的重要性,特别是对近期诊断的患者。