Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, QC, Canada.
Clinique J.-P. Mottard, Hôpital en santé mentale Albert-Prévost, Montreal, QC, Canada.
Acta Psychiatr Scand. 2019 Apr;139(4):336-347. doi: 10.1111/acps.13011.
The experience of pre-onset subthreshold psychotic symptoms (STPS, signifying a clinical high-risk state) in first episode psychosis (FEP) predicts poorer outcomes during treatment, possibly through differential adherence to medication. We explored whether adherence differs between FEP patients with and without pre-onset STPS.
Antipsychotic medication adherence was compared in 263 STPS+ and 158 STPS- subjects in a specialized early intervention program for FEP. Data were gathered from a larger observational study conducted between 2003 and 2016. STPS status, sociodemographic, and baseline clinical variables were tested as predictors of non-adherence using univariate and multivariate logistic regressions. Time to onset of non-adherence was analyzed using Kaplan-Meier curves. The same predictors were tested as predictors of time to onset of non-adherence using Cox regression models.
Medication non-adherence was higher in STPS+ participants (78.9% vs. 68.9%). STPS status (OR 1.709), substance use disorder (OR 1.767), and milder positive symptoms (OR 0.972) were significant baseline predictors of non-adherence. Substance use disorder (HR 1.410), milder positive symptoms (HR 0.990), and lack of contact between the clinical team and relatives (HR 1.356) were significant baseline predictors of time to non-adherence.
FEP patients who experience pre-onset STPS are more likely to be non-adherent to antipsychotic medication over 2 years of intervention. FEP programs should routinely evaluate pre-onset symptomatology to deliver more personalized treatments, with emphasis on engaging both patients and family members from the beginning of care.
首发精神病（FEP）患者发病前出现亚临床精神病症状（STPS，提示临床高风险状态）的经历可预测治疗期间的预后较差，这可能是通过药物治疗的依从性差异所致。我们探讨了 FEP 患者中是否存在 STPS 前和 STPS 后患者之间的药物治疗依从性差异。
在一个专门针对 FEP 的早期干预项目中，比较了 263 名 STPS+和 158 名 STPS-患者的抗精神病药物依从性。数据来自于 2003 年至 2016 年期间进行的一项更大的观察性研究。使用单变量和多变量逻辑回归分析，将 STPS 状态、社会人口统计学和基线临床变量作为非依从性的预测因子进行检验。使用 Kaplan-Meier 曲线分析非依从性的发病时间。使用 Cox 回归模型，将相同的预测因子作为非依从性发病时间的预测因子进行检验。
STPS+患者的药物治疗不依从率更高（78.9% vs. 68.9%）。STPS 状态（OR 1.709）、物质使用障碍（OR 1.767）和较轻的阳性症状（OR 0.972）是不依从的显著基线预测因子。物质使用障碍（HR 1.410）、较轻的阳性症状（HR 0.990）和临床团队与家属之间缺乏联系（HR 1.356）是不依从发病时间的显著基线预测因子。
经历发病前 STPS 的 FEP 患者在 2 年的干预过程中更有可能不依从抗精神病药物治疗。FEP 项目应常规评估发病前的症状，以提供更个性化的治疗，从护理开始就强调与患者和家属建立联系。
