Chiliza Bonginkosi, Asmal Laila, Kilian Sanja, Phahladira Lebogang, Emsley Robin
Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
Hum Psychopharmacol. 2015 May;30(3):173-82. doi: 10.1002/hup.2469. Epub 2015 Mar 11.
The goals of this study were to (i) estimate the rate of non-response to first-line treatment in first-episode schizophrenia, (ii) evaluate other outcomes associated with symptom non-response and (iii) identify demographic, baseline clinical and early treatment response predictors of non-response.
This was a single-site, longitudinal cohort study assessing the effects of treatment with flupenthixol decanoate according to a standardised protocol over 12 months in patients with schizophrenia, schizophreniform and schizo-affective disorders.
Of 126 patients who received at least one dose of study medication, 84 (67%) completed the study. Fifteen (12%) met our predefined criteria for non-response. Non-responders were younger and at baseline had more prominent disorganised symptoms, poorer social and occupational functioning, poorer quality of life for psychological, social and environmental domains, more prominent neurological soft signs (NSS) and lower body mass index. At endpoint, the non-responders were characterised by higher levels of symptomatology in all domains, poorer functional outcome, poorer quality of life and greater cognitive impairments. They also had more prominent NSS and lower body mass index. The strongest predictors of non-response were more prominent baseline NSS and poor early (7 weeks) treatment response.
Results are consistent with a lower rate of refractoriness to treatment in first-episode schizophrenia compared with multi-episode samples.
本研究的目的是：（i）估计首发精神分裂症患者对一线治疗无反应的发生率；（ii）评估与症状无反应相关的其他结局；（iii）确定无反应的人口统计学、基线临床和早期治疗反应预测因素。
这是一项单中心纵向队列研究，根据标准化方案，对精神分裂症、精神分裂症样障碍和分裂情感性障碍患者进行12个月的癸酸氟奋乃静治疗效果评估。
在126名至少接受一剂研究药物的患者中，84名（67%）完成了研究。15名（12%）符合我们预先定义的无反应标准。无反应者年龄较小，基线时紊乱症状更突出，社会和职业功能较差，心理、社会和环境领域的生活质量较差，神经学软体征（NSS）更突出，体重指数较低。在终点时，无反应者的特征是所有领域的症状水平较高、功能结局较差、生活质量较差和认知障碍更严重。他们的NSS也更突出，体重指数更低。无反应的最强预测因素是基线时更突出的NSS和早期（7周）治疗反应不佳。
与多发作样本相比，首发精神分裂症患者治疗难治率较低，本研究结果与之相符。
