Division of Psychiatry, Haukeland University Hospital, Sandviken, Norway.
BMC Psychiatry. 2013 Sep 30;13:241. doi: 10.1186/1471-244X-13-241.
Hallucinations are prevalent in schizophrenia and related psychotic disorders and may have severe consequences for the affected patients. Antipsychotic drug trials that specifically address the anti-hallucinatory effectiveness of the respective drugs in representative samples are rare. The aims of the present study were to investigate the rate and severity of hallucinations in acutely admitted psychotic patients at hospital admission and discharge or after 6 weeks at the latest, if not discharged earlier (discharge/6 weeks); and to compare the anti-hallucinatory effectiveness of risperidone, olanzapine, quetiapine, and ziprasidone with up to 2 years' follow-up.
Adult patients acutely admitted to an emergency ward for psychosis were consecutively randomized to risperidone, olanzapine, quetiapine, or ziprasidone and followed for up to 2 years in a pragmatic design. Participants were assessed repeatedly using the hallucinatory behavior item of the Positive and Negative Syndrome Scale (PANSS).
A total of 226 patients, 30.5% of those assessed for eligibility, were randomized and 68% were hallucinating at baseline. This proportion was reduced to 33% at discharge/6 weeks. In the primary analyses based on intention to treat groups of patients experiencing frequent hallucinations, the quetiapine and ziprasidone groups both had faster decreases of the mean hallucination scores than the risperidone group.
Hallucinations are fairly responsive to antipsychotic drug treatment and differential anti-hallucinatory effectiveness may be found among existing antipsychotic drugs. If replicated, this could pave the way for a more targeted pharmacotherapy based on individual symptom profiles, rather than on the diagnostic category.
ClinicalTrials.gov ID; NCT00932529.
幻觉在精神分裂症和相关的精神病障碍中很常见，可能会对受影响的患者产生严重后果。专门针对特定药物在代表性样本中抗幻觉效果的抗精神病药物试验很少。本研究的目的是调查急性入院的精神病患者在入院时、出院时或最迟在 6 周时（如果提前出院则更早）的幻觉发生率和严重程度；并比较利培酮、奥氮平、喹硫平和齐拉西酮的抗幻觉效果，随访时间长达 2 年。
连续将急性入住精神病急诊病房的成年患者随机分配至利培酮、奥氮平、喹硫平和齐拉西酮组，并在实用设计中随访长达 2 年。使用阳性和阴性综合征量表（PANSS）的幻觉行为项目对参与者进行反复评估。
共有 226 名患者（评估合格人数的 30.5%）被随机分组，68%的患者在基线时有幻觉。这一比例在出院/6 周时降至 33%。在基于有频繁幻觉的意向治疗组患者的主要分析中，喹硫平和齐拉西酮组的平均幻觉评分下降速度均快于利培酮组。
幻觉对抗精神病药物治疗反应良好，现有抗精神病药物可能具有不同的抗幻觉效果。如果得到复制，这可能为基于个体症状谱而不是诊断类别进行更有针对性的药物治疗铺平道路。
ClinicalTrials.gov ID；NCT00932529。
