Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.
Advocoate Aurora Health, Downers Grove, IL, USA.
Psychol Med. 2022 Oct;52(13):2681-2691. doi: 10.1017/S0033291720004778. Epub 2021 Feb 8.
Studies that examine course and outcome in psychosis have reported considerable heterogeneity in terms of recovery, remission, employment, symptom presentation, social outcomes, and antipsychotic medication effects. Even with demonstrated heterogeneity in course and outcome, prophylactic antipsychotic maintenance therapy remains the prominent practice, particularly in participants with schizophrenia. Lack of efficacy in maintenance antipsychotic treatment and concerns over health detriments gives cause to re-examine guidelines.
This study was conducted as part of the Chicago follow-up study designed as a naturalistic prospective longitudinal research study to investigate the course, outcome, symptomatology, and effects of antipsychotic medication on recovery and rehospitalization in participants with serious mental illness disorders. A total of 139 participants with 734 observations were included in the analysis. GEE logistic models were applied to adjust for confounding factors measured at index hospitalization and follow-ups.
Our data show that the majority of participants with schizophrenia or affective psychosis experience future episodes of psychosis at some point during the 20-year follow-up. There was a significant diagnostic difference between groups showing an increase in the number of future episodes of psychosis in participants with schizophrenia. Participants with schizophrenia not on antipsychotics after the first 2 years have better outcomes than participants prescribed antipsychotics. The adjusted odds ratio of not on antipsychotic medication was 5.989 (95% CI 3.588-9.993) for recovery and 0.134 (95% CI 0.070-0.259) for rehospitalization. That is, regardless of diagnosis, after the second year, the absence of antipsychotics predicted a higher probability of recovery and lower probability of rehospitalization at subsequent follow-ups after adjusting for confounders.
This study reports multiple findings that bring into question the use of continuous antipsychotic medications, regardless of diagnosis. Even when the confound by indication for prescribing antipsychotic medication is controlled for, participants with schizophrenia and affective psychosis do better than their medicated cohorts, strongly confirming the importance of exposing the role of aiDSP and antipsychotic drug resistance.
研究表明，精神分裂症患者的病程和结局存在很大的异质性，包括康复、缓解、就业、症状表现、社会结局和抗精神病药物的效果等方面。即使病程和结局存在显著的异质性，预防性抗精神病维持治疗仍然是主要的治疗方法，尤其是在精神分裂症患者中。维持抗精神病药物治疗无效以及对健康损害的担忧，使得重新审查指南成为必要。
这项研究是作为芝加哥随访研究的一部分进行的，该研究是一项自然前瞻性纵向研究，旨在调查严重精神疾病患者的病程、结局、症状表现以及抗精神病药物对康复和再住院的影响。共有 139 名参与者，734 次观察结果被纳入分析。应用广义估计方程逻辑模型来调整指数住院和随访时测量的混杂因素。
我们的数据显示，大多数精神分裂症或情感性精神病患者在 20 年的随访期间，在某个时候会经历未来的精神病发作。两组之间存在显著的诊断差异，精神分裂症患者未来精神病发作的次数增加。在最初的 2 年后不服用抗精神病药物的精神分裂症患者比服用抗精神病药物的患者预后更好。未服用抗精神病药物的调整后优势比（OR）为 5.989（95%CI 3.588-9.993），用于康复，0.134（95%CI 0.070-0.259）用于再住院。也就是说，无论诊断如何，在第二年之后，在调整混杂因素后，不服用抗精神病药物预示着在随后的随访中康复的可能性更高，再住院的可能性更低。
这项研究报告了多项发现，这些发现对连续使用抗精神病药物提出了质疑，无论诊断如何。即使控制了抗精神病药物处方的指示性混杂因素，精神分裂症和情感性精神病患者的表现也优于他们接受药物治疗的患者，这强烈证实了揭示 AI DSP 和抗精神病药物耐药性作用的重要性。
