Potkin Steven G, Bera Rimal, Eramo Anna, Lau Gina
Clin Schizophr Relat Psychoses. 2017 Winter;10(4):211-221. doi: 10.3371/CSRP.PORI.050614. Epub 2014 May 20.
Long-acting injectable (LAI) antipsychotics improve treatment outcomes in patients with schizophrenia but are often reserved for only the most severely affected or nonadherent. Studies show cultural/racial differences in prescribing. This pilot study examined prescriber-patient interactions and cultural/racial differences in perceptions of LAIs among patients.
A linguist analyzed 120 prescriber-patient conversations representing selected patient cultural/racial subgroups (European American, African American, Latino American; n=40 each) to identify similarities and differences in conceptualization and attitudes toward LAIs.
Of 35 LAI-naive patients offered LAIs, 9% (3/35) responded favorably, 46% (16/35) were neutral/passive, and 46% (16/35) had concerns or viewed LAIs as unfavorable. Among LAI-naive patients, favorable or neutral/passive responses were reported for 50% (7/14) of European Americans, 63% (10/16) of African Americans, and 40% (2/5) of Latino Americans. The majority of LAI-naive patients (57% [20/35]) accepted LAI prescriptions, including 53% (17/32) of those who initially were neutral/passive or refused treatment (European American, 42% [5/12]; African American, 53% [8/15]; Latino American, 80% [4/5]). Fifty-seven percent (68/120) of patients expressed treatment goals. Goals of positive/negative symptom control were associated with positive attitudes toward LAIs while patients with goals focused on control of anxiety and insomnia tended to have negative attitudes toward LAIs. Latino-American patients who expressed treatment goals seemed more focused on discomfort control (67% [12/18]); goals of European Americans and African Americans were more equally distributed.
Equal numbers of LAI-naive patients had unfavorable/concerned or neutral/passive attitudes toward treatment; relatively few patients responded favorably. The limited sample size precludes cultural/racial-specific conclusions.
长效注射用抗精神病药物可改善精神分裂症患者的治疗效果，但通常仅用于病情最严重或依从性最差的患者。研究表明，在处方开具方面存在文化/种族差异。这项试点研究考察了医患互动以及患者对长效注射用抗精神病药物认知的文化/种族差异。
一名语言学家分析了120段医患对话，这些对话代表了选定的患者文化/种族亚组（欧裔美国人、非裔美国人、拉丁裔美国人；各40例），以确定在对长效注射用抗精神病药物的概念化和态度方面的异同。
在35例未使用过长效注射用抗精神病药物的患者中，9%（3/35）给予肯定回应，46%（16/35）持中立/消极态度，46%（16/35）表示担忧或将长效注射用抗精神病药物视为不利。在未使用过长效注射用抗精神病药物的患者中，欧裔美国人中有50%（7/14）给予肯定或中立/消极回应，非裔美国人中有63%（10/16），拉丁裔美国人中有40%（2/5）。大多数未使用过长效注射用抗精神病药物的患者（57%[20/35]）接受了长效注射用抗精神病药物处方，包括最初持中立/消极态度或拒绝治疗的患者中的53%（17/32）（欧裔美国人，42%[即5/12]；非裔美国人，53%[即8/15]；拉丁裔美国人，80%[即4/5]）。57%（68/120）的患者表达了治疗目标。阳性/阴性症状控制目标与对长效注射用抗精神病药物的积极态度相关联，而以控制焦虑和失眠为目标的患者往往对长效注射用抗精神病药物持消极态度。表达了治疗目标的拉丁裔美国患者似乎更关注不适控制（67%[12/18]）；欧裔美国人和非裔美国人的目标分布更为均衡。
未使用过长效注射用抗精神病药物的患者中，对治疗持不利/担忧或中立/消极态度的人数相等；给予肯定回应的患者相对较少。样本量有限，无法得出针对特定文化/种族的结论。
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