Zipursky Robert B, Cunningham Charles E, Stewart Bailey, Rimas Heather, Cole Emily, Vaz Stephanie McDermid
Department of Psychiatry and Behavioural Neuroscience, Michael G. DeGroote School of Medicine, McMaster University, 100 West 5th Street, Hamilton, Ontario L8N3K7, Canada; Schizophrenia and Community Integration Service, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, Ontario L8N3K7, Canada.
Department of Psychiatry and Behavioural Neuroscience, Michael G. DeGroote School of Medicine, McMaster University, 100 West 5th Street, Hamilton, Ontario L8N3K7, Canada; McMaster Children's Hospital, Ron Joyce Children's Health Centre, 237 Barton Street East, Hamilton, Ontario, Canada L8L 2X2.
Schizophr Res. 2017 Jul;185:107-113. doi: 10.1016/j.schres.2016.12.018. Epub 2016 Dec 27.
The majority of individuals with schizophrenia will achieve a remission of psychotic symptoms, but few will meet criteria for recovery. Little is known about what outcomes are important to patients. We carried out a discrete choice experiment to characterize the outcome preferences of patients with psychotic disorders. Participants (N=300) were recruited from two clinics specializing in psychotic disorders. Twelve outcomes were each defined at three levels and incorporated into a computerized survey with 15 choice tasks. Utility values and importance scores were calculated for each outcome level. Latent class analysis was carried out to determine whether participants were distributed into segments with different preferences. Multinomial logistic regression was used to identify predictors of segment membership. Latent class analysis revealed three segments of respondents. The first segment (48%), which we labeled "Achievement-focused," preferred to have a full-time job, to live independently, to be in a long-term relationship, and to have no psychotic symptoms. The second segment (29%), labeled "Stability-focused," preferred to not have a job, to live independently, and to have some ongoing psychotic symptoms. The third segment (23%), labeled "Health-focused," preferred to not have a job, to live in supervised housing, and to have no psychotic symptoms. Segment membership was predicted by education, socioeconomic status, psychotic symptom severity, and work status. This study has revealed that patients with psychotic disorders are distributed between segments with different outcome preferences. New approaches to improve outcomes for patients with psychotic disorders should be informed by a greater understanding of patient preferences and priorities.
大多数精神分裂症患者的精神病症状会得到缓解，但很少有人能达到康复标准。对于患者来说哪些结果很重要，我们知之甚少。我们进行了一项离散选择实验，以描述精神病患者的结果偏好。参与者（N = 300）从两家专门治疗精神病的诊所招募。十二个结果各定义为三个水平，并纳入一个包含15个选择任务的计算机化调查中。计算每个结果水平的效用值和重要性得分。进行潜在类别分析以确定参与者是否被分为具有不同偏好的细分群体。使用多项逻辑回归来确定细分群体成员的预测因素。潜在类别分析揭示了三类受访者。第一类（48%），我们称之为“以成就为重点”，他们更倾向于有一份全职工作、独立生活、处于长期关系中且没有精神病症状。第二类（29%），称为“以稳定为重点”，他们更倾向于没有工作、独立生活且有一些持续的精神病症状。第三类（23%），称为“以健康为重点”，他们更倾向于没有工作、住在有监管的住所且没有精神病症状。细分群体成员身份由教育程度、社会经济地位、精神病症状严重程度和工作状态预测。这项研究表明，精神病患者分布在具有不同结果偏好的细分群体之间。改善精神病患者治疗结果的新方法应该基于对患者偏好和优先事项的更深入理解。
