Veldzicht Center for Transcultural Psychiatry, Custodial Institutions Agency (DJI), Ministry of Justice and Security, Balkbrug, the Netherlands; i-psy Haaglanden, Parnassia Group Mental Health Service, Den Haag, the Netherlands; Maastricht University, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht, the Netherlands.
Maastricht University, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht, the Netherlands; Psychiatric Center GGz Centraal, Amersfoort, the Netherlands.
Schizophr Res. 2022 May;243:187-194. doi: 10.1016/j.schres.2022.03.008. Epub 2022 Apr 6.
There is little evidence to support the use of antipsychotic polypharmacy, and there are concerns about safety and side effects. Nonetheless, it is commonly used in the treatment of long-term inpatients with schizophrenia. This study investigated the effects of switching from a combination of first- and second-generation antipsychotics (FGA and SGA) to monotherapy (FGA or SGA) on relapse rates and psychiatric symptomatology.
Institutionalized patients with chronic psychotic disorders using a combination of SGA and FGA (n = 136) participated in a randomized open-label trial. The SWITCH group discontinued either FGA or SGA, the STAY group continued combination treatment. Relapse and psychotic symptoms were measured at baseline and during follow-up at 3, 6, and 9 months. Psychiatric symptomatology was measured using the Brief Psychiatric Rating Scale (BPRS). Relapse was defined as (i) an increase in BPRS score of at least 2 points on any item, or (ii) an increase of at least 4 points in total BPRS score and an adjustment of antipsychotics.
A logistic regression model, corrected for sex, showed that the probability of relapse was significantly lower in the SWITCH group: 0.29 (95% CI 0.13-0.62). The protective effect of switching to monotherapy was attributable to patients continuing clozapine as monotherapy. For patients who did not experience a relapse nor dropped out, BPRS total scores decreased significantly more in the SWITCH group (p = 0.0001).
Switching from a combination of FGA and SGA to monotherapy in long-term inpatients does not increase the relapse rate and may even reduce it.
抗精神病药联合用药的证据有限，且存在安全性和副作用方面的担忧。尽管如此，它在治疗长期住院的精神分裂症患者中仍被广泛应用。本研究旨在调查将第一代和第二代抗精神病药（FGA 和 SGA）联合用药转换为单一药物（FGA 或 SGA）治疗对复发率和精神症状的影响。
采用随机开放标签试验，纳入使用 SGA 和 FGA 联合治疗的慢性精神病患者（n=136）。SWITCH 组停止使用 FGA 或 SGA，STAY 组继续联合治疗。在基线时和随访的 3、6 和 9 个月时评估复发和精神症状。使用简明精神病评定量表（BPRS）测量精神病症状。复发定义为：（i）任何项目的 BPRS 评分至少增加 2 分，或（ii）总 BPRS 评分至少增加 4 分，且调整抗精神病药物。
校正性别后，逻辑回归模型显示，SWITCH 组的复发概率显著降低：0.29（95%CI 0.13-0.62）。转换为单一疗法的保护作用归因于继续使用氯氮平作为单一疗法的患者。对于未复发且未退出的患者，SWITCH 组的 BPRS 总分显著下降（p=0.0001）。
长期住院患者从 FGA 和 SGA 的联合用药转换为单一药物治疗不会增加复发率，甚至可能降低复发率。
