Department of Psychiatry, Okayama Psychiatric Medical Center, Okayama, Japan.
Department of Psychiatry, Okinawa Miyako Hospital, Miyakojima, Japan.
Early Interv Psychiatry. 2019 Jun;13(3):589-597. doi: 10.1111/eip.12531. Epub 2017 Dec 12.
Early clinical response predicts symptomatic remission and recovery in the maintenance treatment phase of first-episode schizophrenia (FES). However, little is known about predictors of symptomatic remission during acute treatment of severely ill patients with FES. Here, we conducted a secondary analysis of our retrospective observational study, which examined response, remission and treatment-resistance rates in seriously ill patients with FES spectrum disorders involuntarily hospitalized and treated with algorithm-based pharmacotherapy.
We performed a retrospective chart review of 131 involuntarily admitted patients with schizophrenia or schizoaffective disorder. Our algorithm aimed to delay olanzapine treatment, standardize medications and suggest initiation of clozapine after failure of third-line antipsychotic treatment. The duration of each adequate antipsychotic treatment at an optimal dosage was 4 weeks or more. Remission was defined using the symptom-severity component of consensus remission criteria. A logistic regression model was applied to identify significant predictors of remission at discharge.
Overall, 74 patients (56%) were in remission at discharge. Non-remitters were hampered from becoming remitters mainly by the presence of negative symptoms. There were no differences in first-line antipsychotics, dosage of antipsychotics at time of response and adherence rates to algorithm-based pharmacotherapy between remitters and non-remitters. Shorter duration of untreated psychosis, favourable early response and less negative symptoms at baseline were identified as independent predictors of remission at discharge.
The importance of early intervention and specific and adequate treatments of negative symptoms is highlighted.
首发精神分裂症（FES）维持治疗阶段的早期临床反应可预测症状缓解和康复。然而，对于 FES 重度患者急性治疗期间症状缓解的预测因素知之甚少。在这里，我们对我们的回顾性观察研究进行了二次分析，该研究检查了 131 名非自愿住院且接受基于算法的药物治疗的 FES 谱系障碍严重患者的反应、缓解和治疗抵抗率。
我们对 131 名非自愿入院的精神分裂症或分裂情感障碍患者进行了回顾性图表审查。我们的算法旨在延迟奥氮平治疗，规范药物治疗，并在三线抗精神病药物治疗失败后建议开始氯氮平治疗。每种足够剂量的抗精神病药物的治疗持续时间为 4 周或更长。缓解定义为使用共识缓解标准的症状严重程度组成部分。应用逻辑回归模型确定出院时缓解的显著预测因素。
总体而言，74 名患者（56%）在出院时缓解。非缓解者主要因存在阴性症状而无法成为缓解者。缓解者和非缓解者在一线抗精神病药物、反应时的抗精神病药物剂量和基于算法的药物治疗依从率方面没有差异。未治疗精神病的持续时间较短、早期反应良好和基线时阴性症状较少被确定为出院时缓解的独立预测因素。
强调了早期干预和针对阴性症状的具体和充分治疗的重要性。
