Sorokin M Yu, Lutova N B, Wied V D
Bekhterev National Research Center for Psychiatry and Neurology, St. Petersburg, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2022;122(1. Vyp. 2):73-79. doi: 10.17116/jnevro202212201273.
To describe the connections between strategies for antipsychotic prescribing and clinical, socio-psychological factors of treatment adherence in patients with psychotic disorders.
The study included 83 inpatients with schizophrenic spectrum disorders (F2x) - 67%, affective disorders (F3x) - 15%, neurotic and personality (F4x + F6x) - 9%, organic diseases of the central nervous system (F0x) - 9%. We used a visual analog scale for patients' subjective severity of their condition, locus control test, Internalized stigma of mental disorder scale (ISMI), Treatment motivation assessment questionnaire (TMAQ), and Medication Compliance Scale (MCS), which also includes BPRS, SANS, GAF scales. Dispersion analysis (≤0.05), effect sizes calculation (Cohen's d/Cramer's V) were performed (ES).
The options for prescribed antipsychotics did not depend on positive and negative symptoms, social maladjustment, suicidality, disease recurrence. The outpatient use of more than one antipsychotic was associated with socio-demographic differences in patients, high internality in life failures (ES=0.98), self-stigmatization (ES=0.94) due to the psychiatric stereotypes endorsement (ES=1.03), and social self-isolation (ES=1.08). Prescription of atypical antipsychotics during hospitalization was associated with subjectively less severe condition in patients (ES=0.7), their position of active cooperation with a doctor (ES=1.08), high internality of achievements (ES=0.99), lower psychiatric stereotypes endorsement (ES=1.19), social self-isolation (ES=1.58). Depot antipsychotic was predominantly an option for patients with secondary education (ES=0.34).
Types and forms of antipsychotic treatment were associated not with clinical but with social and psychological patients' characteristics. The prescription of atypical antipsychotics, including depot forms, is specifically associated with not only treatment adherence, but with a favorable profile of patients' motivation for treatment.
描述抗精神病药物处方策略与精神障碍患者治疗依从性的临床、社会心理因素之间的联系。
该研究纳入了83名住院患者，其中精神分裂症谱系障碍（F2x）患者占67%，情感障碍（F3x）患者占15%，神经症和人格障碍（F4x + F6x）患者占9%，中枢神经系统器质性疾病（F0x）患者占9%。我们使用视觉模拟量表评估患者病情的主观严重程度，采用控制点测试、精神障碍内化耻辱感量表（ISMI）、治疗动机评估问卷（TMAQ）以及药物依从性量表（MCS），MCS还包括简明精神病评定量表（BPRS）、阴性症状评定量表（SANS）、大体功能评定量表（GAF）。进行了方差分析（≤0.05）和效应量计算（科恩d系数/克莱默V系数）（ES）。
所开抗精神病药物的选择并不取决于阳性和阴性症状、社会适应不良、自杀倾向、疾病复发情况。门诊使用多种抗精神病药物与患者的社会人口统计学差异、生活失败的高度内控性（ES = 0.98）、因认可精神科刻板印象导致的自我污名化（ES = 0.94）以及社会自我隔离（ES = 1.08）有关。住院期间使用非典型抗精神病药物与患者主观病情较轻（ES = 0.7）、他们与医生积极合作的态度（ES = 1.08）、成就的高度内控性（ES = 0.99）、较低的精神科刻板印象认可度（ES = 1.19）、社会自我隔离（ES = 1.58）有关。长效抗精神病药物主要是中等教育程度患者的选择（ES = 0.34）。
抗精神病治疗的类型和形式与患者的临床特征无关，而与社会和心理特征有关。包括长效剂型在内的非典型抗精神病药物的处方不仅与治疗依从性有关，还与患者良好的治疗动机特征有关。
