Medrano Sofia, Abdel-Baki Amal, Stip Emmanuel, Potvin Stéphane
Medrano, MD, Clinique JAP, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada, and CHUM research centre, Montreal, Quebec, Canada. Abdel-Baki, MD, MSc, Clinique JAP, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada, Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada, and CHUM research centre, Montreal, Quebec, Canada. Stip, MD, and Potvin, PhD, Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada, and Centre de recherche Fernand-Séguin, Institut universitaire en santé mentale de Montréal, Montreal, Quebec, Canada.
Psychopharmacol Bull. 2018 Jun 20;48(4):25-61.
Poor adherence to antipsychotics, which affects outcome, is frequent in first episode psychosis (FEP). Most randomized studies demonstrate no superiority of long-acting injectable antipsychotics (LAI-AP) over oral antipsychotics (OAP). However, participants in these studies represent a minority of patients who may benefit from LAI-AP. Mirror and naturalistic studies generally demonstrate efficacy of LAI-AP on more representative samples, but studies on FEP are scarce.
To describe LAI-AP's utilization and impact on FEP outcome in a naturalistic setting.
A 3-year longitudinal prospective and retrospective descriptive study of all consecutive admissions from two Early Intervention Services for psychosis (EIS) in Montréal, Canada, compared the characteristics and evolution of patients who received LAI-AP for at least 12 months to those who received OAP only.
From 375 FEP patients included, 26,7% received LAI-AP during their follow-up. They were more likely to have poor prognostic factors (male gender, lower premorbid functioning, homelessness, substance use disorder and schizophrenia spectrum diagnoses). Despite a more severe illness and lower functioning in the LAI-AP group, at admission and study endpoint, clinical and functional improvements were observed.
Early prescription of LAI-AP seems beneficial in FEP with poor prognostic factors.
在首发精神病（FEP）中，抗精神病药物依从性差很常见，这会影响治疗结果。大多数随机研究表明长效注射用抗精神病药物（LAI-AP）并不优于口服抗精神病药物（OAP）。然而，这些研究中的参与者只是可能从LAI-AP中获益的少数患者。对照研究和自然主义研究通常表明LAI-AP对更具代表性的样本有效，但关于FEP的研究很少。
描述在自然主义环境中LAI-AP的使用情况及其对FEP结局的影响。
对加拿大蒙特利尔市两个精神病早期干预服务机构（EIS）所有连续入院患者进行为期3年的纵向前瞻性和回顾性描述性研究，比较接受LAI-AP至少12个月的患者与仅接受OAP的患者的特征和病情演变。
在纳入的375例FEP患者中，26.7%在随访期间接受了LAI-AP。他们更有可能具有不良预后因素（男性、病前功能较低、无家可归、物质使用障碍和精神分裂症谱系诊断）。尽管LAI-AP组疾病更严重且功能较低，但在入院时和研究终点时，观察到临床和功能方面的改善。
对于具有不良预后因素的FEP患者，早期使用LAI-AP似乎有益。
