Benelmokhtar Jebril M, Chiliza Bonginkosi, Phahladira Lebogang, Emsley Robin, Asmal Laila
Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
S Afr J Psychiatr. 2021 Mar 9;27:1657. doi: 10.4102/sajpsychiatry.v27i0.1657. eCollection 2021.
Prevention of new episodes during the first 2 years after a first episode of schizophrenia (FES) may delay treatment refractoriness and brain morphological changes over time. However, adherence to treatment is characteristically poor in these patients.
The aim of this study was to examine clinical and sociodemographic factors associated with patient dropout in patients with FES.
This study was set at inpatient and outpatient services at a psychiatric hospital in the Western Cape, between 2007 and 2011.
Data were collected as part of a prospective longitudinal study, which followed up patients with FES treated with flupenthixol decanoate. We examined the relationship between treatment adherence and sociodemographic and clinical factors at baseline and at 24 months. Unadjusted and adjusted logistic regression models were used to determine adherence variables.
A total of 62% of patients completed the 24 months of treatment. Participants with FES and a substance use disorder (dual diagnosis) were at greater risk of dropout ( = 0.01). On univariate analysis, dual diagnosis participants who dropped out were older ( = 0.04) had completed more years of schooling ( = 0.001), older age of onset ( = 0.02) and higher baseline positive symptoms ( = 0.05). On regression analysis, non-completer substance users achieved a higher level of education (odds ratio [OR]: 3.87, confidence interval [CI]: 1.34-11.11, = 0.01).
Substance use disorder was associated with non-adherence to follow up in a cohort of FES patients treated with flupenthixol decanoate. Interventions that take into account age, education and baseline positive symptoms may afford the opportunity to influence adherence and patient outcome.
在精神分裂症首次发作（FES）后的头两年预防新的发作可能会随着时间的推移延迟治疗难治性和脑形态学变化。然而，这些患者的治疗依从性通常较差。
本研究的目的是检查与FES患者治疗中断相关的临床和社会人口学因素。
本研究于2007年至2011年在西开普省一家精神病医院的住院和门诊服务机构进行。
数据收集作为一项前瞻性纵向研究的一部分，该研究对接受癸酸氟哌噻吨治疗的FES患者进行随访。我们在基线和24个月时检查了治疗依从性与社会人口学和临床因素之间的关系。使用未调整和调整后的逻辑回归模型来确定依从性变量。
共有62%的患者完成了24个月的治疗。患有FES和物质使用障碍（双重诊断）的参与者治疗中断的风险更高（P = 0.01）。单因素分析显示，退出研究的双重诊断参与者年龄较大（P = 0.04）、受教育年限更长（P = 0.001）、发病年龄更大（P = 0.02）且基线阳性症状更高（P = 0.05）。回归分析显示，未完成治疗的物质使用者受教育程度更高（优势比[OR]：3.87，置信区间[CI]：1.34 - 11.11，P = 0.01）。
在接受癸酸氟哌噻吨治疗的FES患者队列中，物质使用障碍与随访不依从相关。考虑年龄、教育程度和基线阳性症状的干预措施可能会为影响依从性和患者结局提供机会。
