Centro de Tratamiento Integral-AGC SM-HUCAB-SESPAsturian Mental Health Service, Gijón, Spain; Health Sciences Dt. Camilo J Cela University, Madrid, Spain.
Centro de Tratamiento Integral-AGC SM-HUCAB-SESPAsturian Mental Health Service, Gijón, Spain; Health Sciences Dt. Camilo J Cela University, Madrid, Spain.
Psychiatry Res. 2020 May;287:112479. doi: 10.1016/j.psychres.2019.112479. Epub 2019 Jul 10.
Lack of treatment compliance in patients with schizophrenia is a risk factor that leads to illness-relapse, hospitalization and potentially strengthens suicidal behavior. The purpose of this investigation was to assess treatment adherence, reasons for treatment discharge, suicidal behaviour and impact of route of antipsychotics administration in a group of patients with schizophrenia treated in a comprehensive, community-based, intensive case managed program for people with severe mental illness. And to compare it to previous standard treatment received in mental health units (MHU). An observational, longitudinal, mirror-image study of patients with severe schizophrenia (N = 344) was carried out: ten years of follow-up (Program) and ten years retrospective (MHU). Reasons for treatment discharge, suicide attempts and antipsychotic (AP) medication were recorded. Treatment adherence during the Program was higher than in MHU (abandonment of treatment: 12.2% vs. 84.3% of patients). Forty patients died during follow-up, five of them due to suicide. Suicidal attempts significantly decreased during Program treatment compared to the standard one (7.6% vs. 38.9% of patients). Long-acting injectable (LAI) AP medication was significantly related to this outcome. A combination of intensive case-managed and LAIAP treatment helped to improve compliance and to reduce suicidal behavior compared to standard treatment in patients with severe schizophrenia.
精神分裂症患者治疗依从性差是导致疾病复发、住院和潜在自杀行为的风险因素。本研究旨在评估在综合社区强化病例管理计划中接受治疗的一组精神分裂症患者的治疗依从性、治疗中断原因、自杀行为以及抗精神病药物给药途径的影响，并与精神卫生机构（MHU）之前的标准治疗进行比较。对 344 例严重精神分裂症患者进行了一项观察性、纵向、镜像研究：十年随访（计划）和十年回顾（MHU）。记录了治疗中断的原因、自杀企图和抗精神病药物（AP）的使用情况。与 MHU 相比，计划治疗期间的治疗依从性更高（治疗中断：12.2%对 84.3%的患者）。在随访期间，40 名患者死亡，其中 5 人自杀。与标准治疗相比，计划治疗期间自杀企图显著减少（7.6%对 38.9%的患者）。长效注射（LAI）AP 药物与这一结果显著相关。与标准治疗相比，强化病例管理和 LAIAP 治疗的联合应用有助于改善严重精神分裂症患者的依从性并降低自杀行为。
