Yee Maria Ruiza, Espiridon Eduardo, Oladunjoye Adeolu O, Millsaps Udema, Vora Anish, Harvey Nailah
Psychiatry, Drexel University College of Medicine, Philadelphia, USA.
Psychiatry, Philadelphia College of Osteopathic Medicine, Philadelphia, USA.
Cureus. 2021 Apr 14;13(4):e14490. doi: 10.7759/cureus.14490.
Introduction Patients with serious mental illness (SMI) experience highly intractable symptoms and great levels of dysfunction from their mental illness. Relapse prevention is critical as psychopathology, social and occupational functioning worsen with repeated psychotic episodes. Poor medication adherence is a strong predictor of relapse. Use of long-acting injectable antipsychotics (LAI) is among the most effective treatment specially in the context of non-adherence and yet remains underutilized. This single center retrospective study conducted using the electronic medical record (EMR) of patients enrolled in an Assertive Community Treatment (ACT) program at a community hospital was analyzed as to whether use of LAI among these patients reduce the frequency of emergency room visits and hospitalizations. Materials and methods Single center retrospective study using EMR of patients ages 20 and above who were enrolled at the ACT program at a community hospital from December 1, 2008 to December 31, 2018. Variables were collected from the EMR and de-identified into an Excel spreadsheet for data collation. Analysis was performed using SPSS software package. Results A total of 179 patients enrolled in the ACT program and their hospitalizations were extracted from the EMR. Seventy-six (42.5%) of these hospitalizations had patients on LAI. The hospitalizations were made up of 53.6% male, 81.9% White/Asian, 18.1% Black; 44.1% ages between 36 and 50 years old, 30.2% ages between 18 and 35 years old, and 25.7% greater than 50 years old. There was no difference in age, sex, race, ethnicity, insurance type and time spent in ACT program between those using LAI and those not on LAI. There was a higher proportion of psychiatric hospitalizations among LAI users compared with the non-LAI user group (57.9% vs 37.4%, p = 0.007). However, the two groups did not differ from one another in terms of psychiatric emergency visits (p = 0.266) or frequency of ACT visits (p = 0.062). Conclusion To date, all of the new-generation antipsychotic LAI have demonstrated a statistically and clinically significant decrease of relapse rates over placebo. Despite this, LAIs are not widely prescribed for a variety of reasons, including the reservations of patients, clinicians and payers. It would seem, though, that our patient population at the ACT program do not seem to benefit from use of LAI in relapse prevention. These results are counterintuitive in that one would expect that patients with serious mental illness would benefit from use of LAI. Perhaps, individuals with SMI are a different subset of population and they do not respond as well to LAI.
引言 患有严重精神疾病（SMI）的患者经历着极其难以治疗的症状，且其精神疾病导致了严重的功能障碍。预防复发至关重要，因为随着反复的精神病发作，精神病理学、社会和职业功能会恶化。药物依从性差是复发的一个强有力的预测因素。使用长效注射用抗精神病药物（LAI）是最有效的治疗方法之一，特别是在不依从的情况下，但仍未得到充分利用。本单中心回顾性研究使用了一家社区医院参与积极社区治疗（ACT）项目的患者的电子病历（EMR），分析了这些患者使用LAI是否能降低急诊就诊和住院的频率。
材料和方法 采用单中心回顾性研究，使用2008年12月1日至2018年12月31日在一家社区医院参与ACT项目的20岁及以上患者的EMR。从EMR中收集变量，并对其进行去识别处理，整理到一个Excel电子表格中以便进行数据核对。使用SPSS软件包进行分析。
结果 从EMR中提取了179名参与ACT项目的患者及其住院情况。其中76例（42.5%）住院患者正在使用LAI。这些住院患者中，男性占53.6%，白人/亚洲人占81.9%，黑人占18.1%；44.1%的患者年龄在36至50岁之间，30.2%的患者年龄在18至35岁之间，25.7%的患者年龄大于50岁。使用LAI的患者与未使用LAI的患者在年龄、性别、种族、民族、保险类型以及在ACT项目中的停留时间方面没有差异。与未使用LAI的患者组相比，使用LAI的患者中精神病住院的比例更高（57.9%对37.4%，p = 0.007）。然而，两组在精神病急诊就诊方面（p = 0.266）或ACT就诊频率方面（p = 0.062）没有差异。
结论 迄今为止，所有新一代抗精神病LAI与安慰剂相比，在统计学和临床上均显示出复发率显著降低。尽管如此，由于患者、临床医生和支付方的顾虑等多种原因，LAI并未得到广泛处方。然而，我们ACT项目中的患者群体似乎并未从使用LAI预防复发中获益。这些结果与直觉相反，因为人们原本预期患有严重精神疾病的患者会从使用LAI中获益。也许，患有SMI的个体是一个不同的人群子集，他们对LAI的反应不佳。
