Psychiatry Department, Clinic Schizophrenia Program, Hospital Clínic of Barcelona, Barcelona, Spain.
Int Clin Psychopharmacol. 2013 Jul;28(4):164-70. doi: 10.1097/YIC.0b013e3283611cc3.
Long-acting injectable antipsychotics may offer a relevant improvement in treatment adherence in recent-onset psychosis, leading to a decreased rate of hospital readmission, a better rate of clinical remission and improved psychosocial adjustment. The aim of the study was to compare the clinical remission rates, number of hospital readmissions and personal and social functioning after 2 years between patients with recent-onset schizophrenia (<2 years) in treatment with risperidone long-acting injectable (RLAI) and patients with recent-onset schizophrenia receiving oral antipsychotics. This is a case-control study comparing patients with recent-onset schizophrenia who initiated RLAI treatment between 2004 and 2008 (n=26) with a control group matched for age and sex, diagnosed with recent-onset schizophrenia and treated with oral antipsychotics (n=26). Study assessments included sociodemographic variables, the Positive and Negative Syndrome Scale, the Personal and Social Functioning Scale, the number of hospital readmissions and the Andreasen remission criteria. To assess the effect of treatment on each dependent variable, separate generalized estimating equations models were constructed. After 2 years of treatment, and adjusting for educational level, the RLAI group showed a greater reduction in the Positive and Negative Syndrome Scale total scale [mean (SD)=47.7 (12.0) vs. 66.2 (18.5); mean difference =-17.56; 95% confidence interval (CI)=-27.11 to -8.00; P<0.001], as well as in the negative [mean (SD) 14.3 (6.1) vs. 19.4 (6.4); mean difference=-5.02; 95% CI=-8.28 to -1.77; P=0.002] and general psychopathology [mean (SD)=23.4 (6.3) vs. 32.7 (8.1); mean difference=-9.16; 95% CI=-13.3 to -5.03; P<0.001] subscales compared with the oral antipsychotic group. Personal and Social Functioning Scale scores were also higher in the RLAI group [mean (SD)=72.4 (14.8) vs. 59.7 (13.5); mean difference=13.41; 95% CI=5.65-21.18; P<0.001]. Although not statistically significant, there were fewer readmissions (adjusted odds ratio 0.28; 95% CI=0.06-1.35; P=0.114) and more illness remissions (adjusted odds ratio 3.24; 95% CI=0.20-11.93; P=0.077) in the RLAI group. Treatment with RLAI instead of oral antipsychotics in recent-onset schizophrenia might improve clinical symptoms and social functioning. The efficacy of RLAI treatment on remission and readmission rates should be researched further.
长效注射型抗精神病药物可能会在近期发病的精神病患者的治疗依从性方面带来显著改善，降低其住院再入院率，提高临床缓解率，并改善社会心理适应。本研究旨在比较近期发病的精神分裂症患者（发病<2 年）接受利培酮长效注射剂（RLAI）治疗和接受口服抗精神病药物治疗的临床缓解率、住院再入院次数以及个人和社会功能。这是一项病例对照研究，比较了 2004 年至 2008 年间接受 RLAI 治疗的近期发病精神分裂症患者（n=26）和接受口服抗精神病药物治疗、匹配年龄和性别的近期发病精神分裂症患者（n=26）。研究评估包括社会人口统计学变量、阳性和阴性综合征量表、个人和社会功能量表、住院再入院次数和 Andreasen 缓解标准。为了评估治疗对每个因变量的影响，分别构建了广义估计方程模型。经过 2 年的治疗后，在校正教育水平后，RLAI 组的阳性和阴性症状量表总分[均值（SD）=47.7（12.0）与 66.2（18.5）；均值差=-17.56；95%置信区间（CI）=-27.11 至 -8.00；P<0.001]以及阴性症状[均值（SD）=14.3（6.1）与 19.4（6.4）；均值差=-5.02；95% CI=-8.28 至 -1.77；P=0.002]和一般精神病理学[均值（SD）=23.4（6.3）与 32.7（8.1）；均值差=-9.16；95% CI=-13.3 至 -5.03；P<0.001]子量表的评分均显著降低，与口服抗精神病药物组相比。RLAI 组的个人和社会功能量表评分也更高[均值（SD）=72.4（14.8）与 59.7（13.5）；均值差=13.41；95% CI=5.65-21.18；P<0.001]。虽然无统计学意义，但 RLAI 组的再入院次数较少（调整后的优势比 0.28；95% CI=0.06-1.35；P=0.114）和缓解的疾病次数更多（调整后的优势比 3.24；95% CI=0.20-11.93；P=0.077）。与口服抗精神病药物相比，在近期发病的精神分裂症患者中使用 RLAI 治疗可能会改善临床症状和社会功能。RLAI 治疗对缓解率和再入院率的疗效需要进一步研究。
