Schizophrenia Program, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Psychiatry, Hongkou Mental Health Center, Shanghai, China.
J Clin Psychiatry. 2016 Nov;77(11):e1460-e1466. doi: 10.4088/JCP.15m10047.
Maintenance treatment of schizophrenia with antipsychotic medications has become a standard for the prevention of psychotic relapse. However, little is known about the effectiveness of antipsychotic drugs for maintenance treatment in "real-world" populations with schizophrenia. We carried out a prospective study to assess the effectiveness of the most frequently prescribed antipsychotic drugs in the maintenance treatment of schizophrenia from 2 community settings.
This study was conducted from October 2011 to December 2014. All participants were diagnosed with schizophrenia according to DSM-IV, were treated with an antipsychotic monotherapy, and were registered in a case management program with monthly monitoring for 24 months. The primary outcome measure, Positive and Negative Syndrome Scale (PANSS), and the Clinical Global Impressions-Severity of Illness (CGI-S) and -Improvement (CGI-I) scales were used to evaluate symptom severity and treatment response. The Personal and Social Performance scale (PSP) was used to evaluate the patients' social functioning. The Medication Adherence Rating Scale (MARS) was used to assess medication adherence behavior. On the basis of antipsychotic used at baseline, patients were clustered into 7 groups: aripiprazole (n = 21), clozapine (n = 84), chlorpromazine (n = 61), olanzapine (n = 34), perphenazine (n = 21), quetiapine (n = 27), and risperidone (n = 99).
Of the 347 patients enrolled in the study, 312 completed the 24-month follow-up. There were no significant differences among the treatment groups in the PANSS total and subscale scores or the CGI-S and CGI-I scores over 24 months (all P values > .05). There were also no significant differences in interactions between PSP scores and antipsychotic drugs (P = .17). The remission rates increased as the follow-time lapsed in all groups, but no significant difference was observed in remission rates at each time point among the 7 groups (P values > .05). At the endpoint, MARS total scores were over 6, but did not significantly differ among the studied drugs (P = .24).
These findings suggest that antipsychotic drugs can achieve equivalent effectiveness in maintenance treatment of first-episode schizophrenia through a well-organized case management program and family participation.
抗精神病药物维持治疗精神分裂症已成为预防精神病复发的标准。然而，对于精神分裂症“真实世界”人群中，抗精神病药物维持治疗的有效性知之甚少。我们进行了一项前瞻性研究，以评估从 2 个社区环境中最常开的抗精神病药物在精神分裂症维持治疗中的有效性。
这项研究于 2011 年 10 月至 2014 年 12 月进行。所有参与者均根据 DSM-IV 诊断为精神分裂症，接受抗精神病单药治疗，并在每月监测的病例管理计划中登记，持续 24 个月。主要结局测量指标为阳性和阴性综合征量表（PANSS）以及临床总体印象严重程度（CGI-S）和改善（CGI-I）量表，用于评估症状严重程度和治疗反应。使用个人和社会表现量表（PSP）评估患者的社会功能。使用药物依从性评定量表（MARS）评估药物依从性行为。根据基线时使用的抗精神病药物，将患者分为 7 组：阿立哌唑（n=21）、氯氮平（n=84）、氯丙嗪（n=61）、奥氮平（n=34）、奋乃静（n=21）、喹硫平（n=27）和利培酮（n=99）。
在纳入研究的 347 名患者中，有 312 名完成了 24 个月的随访。在 24 个月的 PANSS 总分和分量表评分以及 CGI-S 和 CGI-I 评分方面，治疗组之间没有显著差异（所有 P 值均>.05）。在 PSP 评分和抗精神病药物之间的交互作用方面也没有显著差异（P=.17）。在所有组中，随着随访时间的延长，缓解率增加，但在 7 个组的每个时间点的缓解率没有显著差异（P 值>.05）。在终点时，MARS 总分超过 6，但在研究药物之间没有显著差异（P=.24）。
这些发现表明，通过精心组织的病例管理计划和家庭参与，抗精神病药物可以在首次发作的精神分裂症维持治疗中达到等效的疗效。
