From the Case Western Reserve University School of Medicine, Cleveland, OH.
J Clin Psychopharmacol. 2020 Nov/Dec;40(6):541-552. doi: 10.1097/JCP.0000000000001282.
There is limited evidence on the use of antipsychotic medications to treat people with schizophrenia in Sub-Saharan Africa (SSA). This systematic literature review identified original research on use of antipsychotic drugs for primary psychotic disorders in SSA, assessed the methodological quality of studies, summarized intervention strategies, and examined patient-level outcomes.
PubMed, PsychInfo, Cochrane Collaboration, African Journals Online, and CINAHL databases were searched for studies in SSA that focused on antipsychotic treatment for primary psychotic disorders and that investigated at least one patient-level outcome. Articles in English and published before April 2019 were included. Epidemiological studies, drug discontinuation studies, studies with drugs other than antipsychotics, and multicenter studies that did not specify SSA results were excluded. An adapted standardized instrument assessed methodological quality.
Twenty-six articles were reviewed. Three levels of evidence were found: single-group reports, quasi-experimental studies, and randomized controlled trials. Study outcomes included change in psychiatric symptoms, adverse effects, remission rates, or change in functional status. Nine studies reported improvements in psychiatric symptoms with antipsychotic medication. Seven studies investigating adverse effects of antipsychotics found that they were associated with an increase in metabolic syndrome. Two studies reported that remission was achieved in most subjects, and one study reported improvements in functional status.
Despite adverse effects, treatment with antipsychotic medications may be beneficial for individuals with primary psychotic disorders in SSA. Apart from South Africa, there is a scarcity of research on antipsychotics from countries in SSA, and there are numerous important gaps in the literature.
在撒哈拉以南非洲（SSA），用于治疗精神分裂症患者的抗精神病药物的使用证据有限。本系统文献综述确定了针对 SSA 原发性精神障碍使用抗精神病药物的原始研究，评估了研究的方法学质量，总结了干预策略，并检查了患者层面的结果。
在 PubMed、PsychInfo、Cochrane 协作网、African Journals Online 和 CINAHL 数据库中搜索了 SSA 中专注于原发性精神障碍的抗精神病药物治疗的研究，这些研究调查了至少一个患者层面的结果。纳入了发表在 2019 年 4 月之前的英文文章。排除了流行病学研究、药物停药研究、使用抗精神病药物以外的药物的研究以及未具体说明 SSA 结果的多中心研究。使用经过改编的标准化工具评估方法学质量。
共审查了 26 篇文章。发现了三个证据水平：单组报告、准实验研究和随机对照试验。研究结果包括精神症状的变化、不良反应、缓解率或功能状态的变化。9 项研究报告抗精神病药物治疗可改善精神症状。7 项研究调查了抗精神病药物的不良反应，发现它们与代谢综合征的增加有关。两项研究报告大多数受试者达到缓解，一项研究报告功能状态改善。
尽管存在不良反应，但在 SSA，抗精神病药物治疗可能对原发性精神障碍患者有益。除南非外，来自 SSA 国家的抗精神病药物研究很少，文献中存在许多重要的空白。
