青少年和青年精神病性障碍的早期检测与综合护理：ACCESS III研究
Early detection and integrated care for adolescents and young adults with psychotic disorders: the ACCESS III study.
作者信息
Lambert M, Schöttle D, Ruppelt F, Rohenkohl A, Sengutta M, Luedecke D, Nawara L A, Galling B, Falk A-L, Wittmann L, Niehaus V, Sarikaya G, Rietschel L, Gagern C, Schulte-Markwort M, Unger H-P, Ott S, Romer G, Daubmann A, Wegscheider K, Correll C U, Schimmelmann B G, Wiedemann K, Bock T, Gallinat J, Karow A
机构信息
Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, UKE, Hamburg, Germany.
出版信息
Acta Psychiatr Scand. 2017 Aug;136(2):188-200. doi: 10.1111/acps.12762. Epub 2017 Jun 6.
OBJECTIVE
The objective of the study was to investigate whether a combined intervention composed of early detection plus integrated care (EDIC) enhances outcomes in patients with early psychosis compared to standard care (SC).
METHODS
ACCESS III is a prospective non-randomized historical control design 1-year study examining the efficacy of EDIC (n = 120) vs. SC (n = 105) in patients aged 12-29 years. Primary outcome was the rate of ≥6 months combined symptomatic and functional remission. Additional outcomes comprised the reduction of DUP and course of psychopathology, functioning, quality of life, and satisfaction with care.
RESULTS
In observed cases, 48.9% in the EDIC and 15.2% in the SC group reached the primary endpoint. Remission was predicted by EDIC (OR = 6.8, CI: 3.15-14.53, P < 0.001); younger age predicted non-remission (OR = 1.1, CI: 1.01-1.19, P = 0.038). Linear regressions indicated a reduction of DUP in EDIC (P < 0.001), but not in SC (P = 0.41). MMRMs showed significantly larger improvements in PANSS positive (P < 0.001) and GAF (P < 0.01) scores in EDIC vs. SC, and in EDIC over time in CGI-Severity (P < 0.001) and numerically in Q-LES-Q-18 (P = 0.052).
CONCLUSIONS
EDIC lead to significantly higher proportions of patients achieving combined remission. Moderating variables included a reduction of DUP and EDIC, offering psychotherapeutic interventions.
目的
本研究的目的是调查与标准护理（SC）相比，由早期检测加综合护理（EDIC）组成的联合干预措施是否能改善早期精神病患者的治疗效果。
方法
ACCESS III是一项前瞻性非随机历史对照设计的1年研究，考察EDIC（n = 120）与SC（n = 105）对12至29岁患者的疗效。主要结局是≥6个月的症状和功能联合缓解率。其他结局包括缩短精神病发病延迟期（DUP）以及精神病理学进程、功能、生活质量和护理满意度。
结果
在观察到的病例中，EDIC组48.9%的患者和SC组15.2%的患者达到主要终点。EDIC可预测缓解情况（比值比[OR]=6.8，置信区间[CI]：3.15 - 14.53，P<0.001）；年龄较小可预测未缓解（OR = 1.1，CI：1.01 - 1.19，P = 0.038）。线性回归表明EDIC组的DUP有所降低（P<0.001），而SC组未降低（P = 0.41）。重复测量混合模型分析（MMRMs）显示，与SC组相比，EDIC组在阳性和阴性症状量表（PANSS）阳性得分（P<0.001）和总体功能评估（GAF）得分（P<0.01）方面有显著更大的改善，且随着时间推移，EDIC组在临床总体印象严重程度量表（CGI - Severity）得分上有显著改善（P<0.001），在生活质量简明量表18项版（Q - LES - Q - 18）得分上有数值上的改善（P = 0.052）。
结论
EDIC使实现联合缓解的患者比例显著更高。调节变量包括DUP的降低以及提供心理治疗干预的EDIC。
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