Bäuml Josef, Pitschel-Walz Gabriele, Volz Anja, Lüscher Sandra, Rentrop Michael, Kissling Werner, Jahn Thomas
Hospital of Psychiatry and Psychotherapy, Technical University of Munich, Munich, Germany
Hospital of Psychiatry and Psychotherapy, Technical University of Munich, Munich, Germany.
Schizophr Bull. 2016 Jul;42 Suppl 1(Suppl 1):S62-70. doi: 10.1093/schbul/sbw008. Epub 2016 Mar 8.
Psychoeducation improves adherence and motivates patients to accept a maintenance therapy as recommended by the guidelines. This would mean a daily consumption of at least 300 chlorpromazine (CPZ) units in the long run and should lead to an increase of the antipsychotic dosage in comparison to patients with treatment as usual (TAU). This raises 2 important questions: whether more side effects are provoked and do the patients have a corresponding benefit with a better outcome. A total of 41 patients with a diagnosis of schizophrenic or schizoaffective disorder were randomized at study entry, either to bifocal psychoeducation (21), or to standard treatment (20). They were compared concerning compliance, type of medication, dosage (CPZ equivalents), motor side effects and number of days in hospital. The average daily antipsychotic medication 2 and 7 years after index discharge was 365 and 354 CPZ-units respectively in the intervention group (IG), but 247 and 279, respectively in the control group (CG). The extent of motor side effects was slightly smaller in the IG, but they showed a small and statistically not significant increase in the rate of tardive dyskinesia (TD) after 7 years. At the 7-year follow-up the patients in the IG had spent 74.7 days in hospital compared to 243.4 days for the patients in the CG (P < .05). The course of illness was significantly better in the IG without increasing motor side-effects. Therefore, psychoeducation should be integrated more systematically into the routine treatment. These data are part of a previous study, published 2007, with a sample size of 48 patients. Seven patients-3 of the IG and 4 of the CG-could not be included, because they were not able to complete the very complex "Computer-based kinematic analysis of motor performance." In this article all conclusions are referred to the new sample size, therefore some results are slightly different in comparison to the previous data.
心理教育可提高依从性，并促使患者接受指南推荐的维持治疗。从长远来看，这意味着每日至少服用300氯丙嗪（CPZ）单位，与接受常规治疗（TAU）的患者相比，抗精神病药物剂量应有所增加。这引发了两个重要问题：是否会引发更多副作用，以及患者是否能通过更好的疗效获得相应益处。共有41例诊断为精神分裂症或分裂情感性障碍的患者在研究开始时被随机分组，分别接受双焦点心理教育（21例）或标准治疗（20例）。对两组患者的依从性、药物类型、剂量（CPZ等效量）、运动副作用及住院天数进行了比较。干预组（IG）出院后2年和7年的平均每日抗精神病药物剂量分别为365和354 CPZ单位，而对照组（CG）分别为247和279。IG组的运动副作用程度略小，但7年后迟发性运动障碍（TD）发生率有小幅上升，且无统计学意义。在7年随访时，IG组患者住院74.7天，而CG组患者住院达243.4天（P < 0.05）。IG组的病程明显更好，且未增加运动副作用。因此，应更系统地将心理教育纳入常规治疗。这些数据是2007年发表的一项样本量为48例患者的前期研究的一部分。有7例患者——IG组3例和CG组4例——未被纳入，因为他们无法完成非常复杂的“基于计算机的运动表现运动学分析”。在本文中，所有结论均基于新的样本量，因此与之前的数据相比，有些结果略有不同。
