Mosjøen District Psychiatric Centre, Helgeland Hospital, Skjervengan 17, 8657 Mosjøen, Norway; Department of Psychology, UiT The Arctic University of Norway, Pb 6050 Langnes, 9037 Tromsø, Norway.
NORMENT Centre of Excellence and Division of Psychiatry, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway; Department of Clinical Medicine, University of Bergen, Pb 7800, 5020 Bergen, Norway.
Schizophr Res. 2022 Aug;246:49-59. doi: 10.1016/j.schres.2022.05.022. Epub 2022 Jun 13.
Antipsychotic medications are generally effective in ameliorating psychotic symptoms in schizophrenia spectrum disorders (SSDs). Identifying predictors associated with poor treatment response is important for a personalized treatment approach. Childhood trauma (CT) may have a general and differential effect on the effectiveness of different types of antipsychotics in SSDs. The Bergen-Stavanger-Trondheim-Innsbruck (BeSt InTro) study is a pragmatic, researcher-initiated, semi-randomized trial. The present study aimed to investigate symptom change (the Positive and Negative Syndrome Scale) from baseline to 1, 3, 6, 12, 26, 39 and 52 weeks of antipsychotic treatment (amisulpride, aripiprazole and olanzapine) by group (CT/no CT). Participants (n = 98) with diagnoses within the schizophrenia spectrum (F20-29 in the International Classification of Diseases - 10th Revision) were randomized to receive amisulpride, aripiprazole or olanzapine, and for this study categorized into groups of none and low CT, and moderate to severe CT according to thresholds defined by the Childhood Trauma Questionnaire Short-Form manual. CT in SSDs predicted an overall slower treatment response and less antipsychotic effectiveness after 26 weeks of treatment, which was statistically nonsignificant at 52 weeks. Secondary analyses showed a differential effect of CT related to type of antipsychotic medication: patients with SSDs and CT who received olanzapine showed less antipsychotic effectiveness throughout 52 weeks of treatment. The intention-to-treat and per-protocol analyses were convergent. Our findings indicate that in patients with SSD and CT, delayed response to antipsychotics could be expected, and a longer evaluation period before considering change of medication may be recommended.
抗精神病药物通常可有效改善精神分裂谱系障碍（SSDs）中的精神病症状。确定与治疗反应不佳相关的预测因素对于个性化治疗方法很重要。儿童创伤（CT）可能对 SSD 中不同类型的抗精神病药物的有效性具有普遍和差异的影响。卑尔根-斯塔万格-特隆赫姆-因斯布鲁克（BeSt InTro）研究是一项实用的、由研究人员发起的、半随机试验。本研究旨在通过组（CT/无 CT）研究抗精神病药物治疗（氨磺必利、阿立哌唑和奥氮平）从基线到 1、3、6、12、26、39 和 52 周时的症状变化（阳性和阴性综合征量表）。患有精神分裂谱系内诊断的参与者（n=98）（国际疾病分类第 10 次修订版 F20-29）被随机分配接受氨磺必利、阿立哌唑或奥氮平治疗，并且根据儿童创伤问卷简式手册定义的阈值，将这些参与者分为无 CT 和低 CT 组以及中重度 CT 组。SSDs 中的 CT 预测治疗 26 周后总体治疗反应较慢且抗精神病药物效果较差，但在 52 周时无统计学意义。二级分析显示 CT 与抗精神病药物类型有关的差异效应：接受奥氮平治疗的 SSD 和 CT 患者在整个 52 周的治疗过程中显示出较少的抗精神病药物效果。意向治疗和按方案分析结果一致。我们的研究结果表明，在患有 SSD 和 CT 的患者中，可能会出现对抗精神病药物的反应延迟，在考虑改变药物之前，可能需要更长的评估期。
