Colizzi Marco, Carra Elena, Fraietta Sara, Lally John, Quattrone Diego, Bonaccorso Stefania, Mondelli Valeria, Ajnakina Olesya, Dazzan Paola, Trotta Antonella, Sideli Lucia, Kolliakou Anna, Gaughran Fiona, Khondoker Mizanur, David Anthony S, Murray Robin M, MacCabe James H, Di Forti Marta
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, United Kingdom.
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, United Kingdom.
Schizophr Res. 2016 Feb;170(2-3):311-7. doi: 10.1016/j.schres.2015.11.016. Epub 2015 Dec 21.
Both substance use and poor medication adherence are associated with poor outcome in psychosis. To clarify the contributions of substance use and poor medication adherence to poor outcome in the year following a first episode of psychosis, 205 patients were evaluated for use of tobacco, alcohol, cannabis and stimulants at their psychosis onset, and in a 1-year follow-up. Data on medication adherence and symptom remission were also collected. Patients had high rates of overall substance use before (37-65%) and after psychosis onset (45-66%). 44% showed poor medication adherence and 55% did not reach remission from psychosis. Nicotine dependence and cannabis use after psychosis onset significantly predicted both poor medication adherence and non-remission, and poor medication adherence mediated the effects of these substances on non-remission. In conclusion, medication adherence lies on the causal pathway between nicotine dependence and cannabis on the one hand and non-remission on the other.
物质使用和药物治疗依从性差均与精神病的不良预后相关。为了阐明物质使用和药物治疗依从性差对首次精神病发作后一年不良预后的影响，对205名患者在精神病发作时及1年随访期间的烟草、酒精、大麻和兴奋剂使用情况进行了评估。还收集了药物治疗依从性和症状缓解的数据。患者在精神病发作前（37%-65%）和发作后（45%-66%）总体物质使用率较高。44%的患者药物治疗依从性差，55%的患者精神病未缓解。精神病发作后尼古丁依赖和大麻使用显著预测了药物治疗依从性差和未缓解，且药物治疗依从性差介导了这些物质对未缓解的影响。总之，药物治疗依从性处于尼古丁依赖和大麻与未缓解之间的因果路径上。
