Department of Pharmacology, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
PLoS One. 2018 Aug 10;13(8):e0199758. doi: 10.1371/journal.pone.0199758. eCollection 2018.
Retrospective data were collected from 330 individuals who were treated at a tertiary care program for treatment-resistant psychosis between 1994 and 2010. The main objectives were to compare the use of antipsychotic monotherapy to polypharmacy and to characterize within-individual changes in treatment and symptomatology between admission and discharge. At admission, individuals who were prescribed only one antipsychotic were comparable to those who were prescribed at least two antipsychotics with regard to demographics and symptom severity. The use of psychotropic medications other than antipsychotics was also similar between the two groups. However, the magnitude of antipsychotic utilization was greater in individuals who were receiving antipsychotic polypharmacy. In addition, a greater proportion received excessive doses at admission. Similar findings were observed when the two antipsychotic prescribing practices were compared at discharge. Three important patterns were identified when investigating within-individual changes. First, fewer individuals were prescribed more than one antipsychotic at discharge. This was accompanied by a general decrease in the magnitude of antipsychotic utilization. Second, the number of individuals who were prescribed clozapine had increased by discharge. Most who were already prescribed clozapine at admission had their doses increased. Third, improvements in symptomatology were observed across all of the subscales included in the Positive and Negative Symptom Scale (PANSS); 57.9% of individuals experienced a relative reduction in total PANSS scores exceeding 20%. Based on these findings, it is possible to alleviate symptom severity while reducing antipsychotic utilization when patients are treated at a tertiary care program for treatment-resistant psychosis.
回顾性数据来自于 1994 年至 2010 年间在一家三级保健项目中接受治疗难治性精神病治疗的 330 名个体。主要目标是比较抗精神病药单药治疗与联合用药的效果，并描述个体在入院和出院期间治疗和症状的个体内变化。在入院时，仅接受一种抗精神病药治疗的个体与接受至少两种抗精神病药治疗的个体在人口统计学和症状严重程度方面具有可比性。除了抗精神病药之外，两组个体接受的精神药物的使用情况也相似。然而，接受抗精神病药联合用药的个体的抗精神病药使用量更大。此外，在入院时，更多的个体接受了过量的抗精神病药。在出院时比较两种抗精神病药的处方实践时，也观察到了类似的发现。当研究个体内变化时，发现了三个重要的模式。首先，出院时，较少的个体接受了超过一种抗精神病药的治疗。这伴随着抗精神病药使用量的普遍减少。其次，出院时，接受氯氮平治疗的个体数量有所增加。大多数在入院时已经接受氯氮平治疗的个体，其剂量有所增加。第三，阳性和阴性症状量表（PANSS）中的所有子量表的症状都有所改善；57.9%的个体的总 PANSS 评分相对降低超过 20%。基于这些发现，在三级保健项目中治疗治疗抵抗性精神病的患者时，可以减轻症状严重程度，同时减少抗精神病药的使用。
