Sajatovic Martha, Ramirez Luis F, Fuentes-Casiano Edna, Cage Jamie, Tatsuoka Curtis, Aebi Michelle E, Bukach Ashley, Cassidy Kristin A, Levin Jennifer B
From the *Department of Psychiatry, W. O. Walker Center; and †Department of Neurology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, OH.
J Clin Psychopharmacol. 2017 Dec;37(6):702-707. doi: 10.1097/JCP.0000000000000778.
Long-acting injectable antipsychotics (LAI) can optimize adherence for high-risk serious mental illness (SMI). This customized adherence-enhancement approach delivered by social worker interventionists was combined with LAI (CAE-L) of paliperidone palmitate for homeless, poorly adherent individuals with SMI.
This 6-month prospective, uncontrolled trial of CAE-L in 30 recently homeless individuals with SMI assessed adherence using the Tablets Routine Questionnaire, injection frequency, and SMI symptoms measured by the Positive and Negative Syndrome Scale, Brief Psychiatric Rating Scale, and Clinical Global Impressions. The Social and Occupational Functioning Assessment Scale measured social function. Standardized scales assessed extrapyramidal effects.
Patients' mean age was 43.6 (SD, 9.53) years, and they were mainly minorities (86.7% African American) and single/never married (72.4%). Rate of substance abuse within the past year was 40.0%, and rate of incarceration within the past 6 months was 32.1%. Four participants (13.3%) terminated the study prematurely. Customized adherence enhancement + LAI was associated with good adherence to LAI (92.9%) and improved adherence with oral drug as measured by Tablets Routine Questionnaire (P = 0.02). There were significant improvements in Positive and Negative Syndrome Scale (P < 0.01), Brief Psychiatric Rating Scale (P < 0.001), Clinical Global Impressions (P = 0.003), and Social and Occupational Functioning Assessment Scale (P = 0.005). There were no significant extrapyramidal effects.
While findings must be tempered by the methodological limitations, CAE-L seems associated with multiple domains of improvement in homeless/recently homeless individuals with SMI. Adverse effects limit tolerability in some individuals, and not all will remain engaged. However, LAI combined with a patient-centered behavioral approach can improve outcomes for some high-risk individuals with SMI.
长效注射用抗精神病药物（LAI）可优化高危严重精神疾病（SMI）患者的依从性。由社会工作干预者提供的这种定制化依从性增强方法与棕榈酸帕利哌酮的长效注射用抗精神病药物（CAE-L）相结合，用于患有严重精神疾病且无家可归、依从性差的个体。
这项针对30名近期无家可归的严重精神疾病患者进行的CAE-L为期6个月的前瞻性、非对照试验，使用片剂常规问卷、注射频率以及通过阳性和阴性症状量表、简明精神病评定量表和临床总体印象量表测量的严重精神疾病症状来评估依从性。社会和职业功能评估量表用于测量社会功能。标准化量表用于评估锥体外系效应。
患者的平均年龄为43.6（标准差，9.53）岁，主要为少数族裔（86.7%为非裔美国人），且单身/从未结婚（72.4%）。过去一年的药物滥用率为40.0%，过去6个月的监禁率为32.1%。四名参与者（13.3%）提前终止了研究。定制化依从性增强 + 长效注射用抗精神病药物与良好的长效注射用抗精神病药物依从性（92.9%）相关，并且通过片剂常规问卷测量显示口服药物依从性有所改善（P = 0.02）。阳性和阴性症状量表（P < 0.01）、简明精神病评定量表（P < 0.001）、临床总体印象量表（P = 0.003）和社会和职业功能评估量表（P = 0.005）均有显著改善。未发现显著的锥体外系效应。
尽管研究结果必须考虑到方法学上的局限性，但CAE-L似乎与患有严重精神疾病的无家可归/近期无家可归个体的多个改善领域相关。不良反应限制了部分个体的耐受性，并非所有人都会持续参与。然而，长效注射用抗精神病药物与以患者为中心的行为方法相结合可以改善一些高危严重精神疾病患者的治疗效果。
