Alisauskiene Renata, Løberg Else-Marie, Gjestad Rolf, Kroken Rune A, Jørgensen Hugo A, Johnsen Erik
a Division of Psychiatry , Haukeland University Hospital , Bergen , Norway.
b Department of Addiction Medicine , Haukeland University Hospital , Bergen , Norway.
Nord J Psychiatry. 2019 May-Jul;73(4-5):281-287. doi: 10.1080/08039488.2019.1622152. Epub 2019 May 29.
Psychosis is associated with a high prevalence of substance use, leading to worsened prognosis. Less is known about how comorbid substance abuse may influence the effectiveness of antipsychotic medications. The aim of this study was to compare the effectiveness of second generation antipsychotics in patients with psychosis with and without substance use. All patients ( = 226) were aged >18 years old had symptom level scores of ≥4 on selected psychosis items on the Positive and Negative Syndrome Scale and met ICD-10 diagnostic criteria for psychosis. Information on substance use was collected based on the Clinician Drug Use Scale. Patients were grouped at baseline according to the presence of substance use, medication history and diagnosis group. Clinical symptoms at baseline and changes at follow-up were assessed with the PANSS. At baseline about 30% of the patients used substances, most frequently cannabis followed by methamphetamine. About half (47%) of the patients had no prior exposure to antipsychotic medication at inclusion. Patients who had consumed substances showed no substantial differences in the PANSS score reduction as a result of antipsychotic medication compared to patients without substance. There were, however, some group differences in relation to pattern of change that were influenced by medication history. Substance use was found to be related to stronger reduction of positive symptoms from week 4 to week 27. Substance use alone did not influence antipsychotic effectiveness in this sample of patients with psychosis.
精神病与物质使用的高患病率相关，导致预后恶化。关于合并物质滥用如何影响抗精神病药物的疗效，人们了解较少。本研究的目的是比较第二代抗精神病药物在有和没有物质使用的精神病患者中的疗效。所有患者（n = 226）年龄大于18岁，在阳性和阴性症状量表上选定的精神病项目上症状水平得分≥4，且符合ICD-10精神病诊断标准。基于临床医生药物使用量表收集物质使用信息。患者在基线时根据物质使用情况、用药史和诊断组进行分组。使用阳性和阴性症状量表评估基线时的临床症状和随访时的变化。在基线时，约30%的患者使用物质，最常见的是大麻，其次是甲基苯丙胺。约一半（47%）的患者在纳入时未曾接触过抗精神病药物。与未使用物质的患者相比，使用过物质的患者在使用抗精神病药物后阳性和阴性症状量表得分降低方面没有实质性差异。然而，在变化模式方面存在一些受用药史影响的组间差异。发现物质使用与从第4周到第27周阳性症状的更强减少有关。在这个精神病患者样本中，单独的物质使用并未影响抗精神病药物的疗效。
