Kreyenbuhl Julie A, Medoff Deborah R, McEvoy Joseph P, Smith Thomas E, Hackman Ann L, Nossel Ilana R, Dixon Lisa B, Essock Susan M, Buchanan Robert W
Dr. Kreyenbuhl, Dr. Medoff, and Dr. Hackman are with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore (e-mail:
Psychiatr Serv. 2016 Dec 1;67(12):1300-1306. doi: 10.1176/appi.ps.201500438. Epub 2016 Jul 1.
This study examined the adherence of psychiatrists to the Schedule of Recommended First and Second Line Antipsychotic Medications ("Antipsychotic Schedule"), which was implemented in two Recovery After an Initial Schizophrenia Episode (RAISE) Connection Program Implementation and Evaluation Study clinics.
Sixty-five individuals with a first episode of psychosis were enrolled in the RAISE Connection Program clinics. Two psychiatrists received training and ongoing consultation on use of a shared decision-making approach to prescribing antipsychotic medications according to the Antipsychotic Schedule. Information about participants, prescribed antipsychotic medications, and completion of side-effect assessments were obtained from standardized research assessments and chart extractions. Descriptive statistics were used to characterize the extent to which patterns of antipsychotic prescribing and side-effect monitoring were consistent with the Antipsychotic Schedule.
Ninety-two percent of participants were prescribed an antipsychotic medication and received the medication on 76%±35% of the days they were in treatment. Seventy-seven percent of participants were prescribed at least one Antipsychotic Schedule first-line antipsychotic, 20% were prescribed olanzapine, and 10% received a trial of clozapine. Regarding monitoring for metabolic side effects, 92% of participants had at least one weight recorded, 72% had at least one blood glucose measure recorded, and 62% had at least one lipid profile recorded.
In the context of a study in which training and ongoing clinical supervision by experts was provided to psychiatrists and shared decision making was encouraged, antipsychotic prescribing patterns closely adhered to recommendations established by the RAISE Connection Program.
本研究考察了精神科医生对《推荐的一线和二线抗精神病药物用药方案》(“抗精神病药物方案”)的遵循情况,该方案在两项首发精神分裂症发作后康复(RAISE)联系项目实施与评估研究诊所中实施。
65名首次发作精神病的个体被纳入RAISE联系项目诊所。两名精神科医生接受了关于根据抗精神病药物方案采用共同决策方法开具抗精神病药物的培训及持续咨询。从标准化研究评估和病历摘录中获取有关参与者、所开抗精神病药物以及副作用评估完成情况的信息。使用描述性统计来描述抗精神病药物处方模式和副作用监测与抗精神病药物方案一致的程度。
92%的参与者开具了抗精神病药物,且在接受治疗的天数中,76%±35%的天数服用了该药物。77%的参与者开具了至少一种抗精神病药物方案中的一线抗精神病药物,20%的参与者开具了奥氮平,10%的参与者接受了氯氮平试验。关于代谢副作用监测,92%的参与者至少记录了一次体重,72%的参与者至少记录了一次血糖测量值,62%的参与者至少记录了一次血脂谱。
在一项向精神科医生提供专家培训和持续临床监督并鼓励共同决策的研究背景下,抗精神病药物处方模式紧密遵循了RAISE联系项目制定的建议。