Tani Hideaki, Tomita Masayuki, Suzuki Takefumi, Mimura Masaru, Uchida Hiroyuki
Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
Kimel Family Translational Imaging-Genetics Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
Clin Psychopharmacol Neurosci. 2021 Nov 30;19(4):773-779. doi: 10.9758/cpn.2021.19.4.773.
While antipsychotics are necessary for relapse prevention in the treatment of schizophrenia in general, some minority of patients may be maintained without continuous antipsychotic treatment. However, the characteristics of such patients are not well known and previous reports have not evaluated key elements such as physical comorbidities and functioning.
Among 635 patients with schizophrenia who participated in a 12-year follow-up, those who were maintained without antipsychotic treatment for at least one year after the study were investigated. The patients underwent comprehensive assessments, including Positive and Negative Syndrome Scale (PANSS) for psychopathology, Cumulative Illness Rating Scale for Geriatrics (CIRS-G) for physical comorbidities, and Functional Assessment for Comprehensive Treatment of Schizophrenia (FACT-Sz), Barthel Index, and EuroQoL five dimensions (EQ5D) for function.
Six patients were included (mean ± standard deviation age, 66.8 ± 17.4 years; 4 inpatients). The four inpatients were old (77.8 ± 4.8 years) and chronically ill (duration of illness, 49.3 ± 12.5 years) with a high PANSS score (total score, 118.0 ± 9.8; negative syndrome subscale, 41.3 ± 6.9), low functioning (FACT-Sz, 9.8 ± 3.6; Barthel Index, 8.8 ± 9.6), and serious physical comorbidities (CIRS-G, 15.5 ± 1.1). By contrast, the two outpatients were relatively young (45.0 ± 12.0 years) and clinically in good condition (PANSS total score, 44.5 ± 0.5; Barthel Index, 100 for both; EQ5D, 0.85 ± 0.04).
Although the number is limited, two types of patients with schizophrenia were identified who were free from ongoing antipsychotic treatment; 1) older chronic inpatients with serious physical comorbidities, and 2) younger outpatients with milder impairments. Future explorations are needed to identify those who will be successfully withdrawn from continuous antipsychotic treatment.
虽然抗精神病药物对于预防精神分裂症复发总体上是必要的，但少数患者可能在不持续使用抗精神病药物治疗的情况下维持病情稳定。然而，这类患者的特征尚不为人所知，并且既往报告并未评估诸如躯体合并症和功能状态等关键因素。
在参与一项为期12年随访研究的635例精神分裂症患者中，对那些在研究结束后至少一年未接受抗精神病药物治疗而病情维持稳定的患者进行调查。这些患者接受了全面评估，包括用于评估精神病理学的阳性与阴性症状量表（PANSS）、用于评估躯体合并症的老年累积疾病评定量表（CIRS - G），以及用于评估功能的精神分裂症综合治疗功能评估量表（FACT - Sz）、巴氏指数和欧洲五维健康量表（EQ5D）。
纳入6例患者（平均年龄±标准差为66.8±17.4岁；4例为住院患者）。4例住院患者年龄较大（77.8±4.8岁）且患有慢性病（病程为49.3±12.5年），PANSS评分较高（总分118.0±9.8；阴性症状分量表41.3±6.9），功能状态较差（FACT - Sz为9.8±3.6；巴氏指数为8.8±9.6），且存在严重的躯体合并症（CIRS - G为15.5±1.1）。相比之下，2例门诊患者相对年轻（45.0±12.0岁）且临床状况良好（PANSS总分44.5±0.5；巴氏指数均为100；EQ5D为0.85±0.04）。
尽管数量有限，但已识别出两类未持续接受抗精神病药物治疗的精神分裂症患者；1）患有严重躯体合并症的老年慢性住院患者，以及2）功能损害较轻的年轻门诊患者。未来需要进一步探索，以确定那些能够成功停用抗精神病药物持续治疗的患者。
