Service of Adult Psychiatry North-West, Department of Psychiatry, Lausanne University Hospital (CHUV), Chemin des Chaux, 1196 Prangins, Switzerland.
Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.
Eur Psychiatry. 2022 Aug 15;65(1):e49. doi: 10.1192/j.eurpsy.2022.2305.
While specialized early intervention programs represent the gold standard in terms of optimal management of first-episode psychosis (FEP), poor medication adherence remains a predominant unmet need in the treatment of psychosis. In this regard, an interaction between insight and adherence in FEP patients has been hypothesized but has been challenged by multiple pitfalls.
Latent profile analysis and trajectory modeling techniques were used to evaluate insight and adherence of 331 FEP patients engaged at the beginning, middle, and end of a 3-year specialized early psychosis program. A Bayesian model comparison approach was used to compare scores of clinical, functional, and socioeconomic outcomes at the end point of the study.
Nearly one-third of the patients maintain a high level of insight and adherence during the entire program. At the end of the 3-year follow-up, more than three-quarters of patients are considered adherent to their medication. Patients with low levels of insight and adherence at the beginning of the program improve first in terms of adherence and then of insight. Furthermore, patients with high levels of insight and adherence are most likely to reach functional recovery and to experience an increase in environmental quality of life.
Latent FEP subpopulations can be identified based on insight and adherence. Medication adherence was the first variable to improve, but a gain in insight possibly plays a role in the reinforcement of adherence.
虽然专门的早期干预项目是治疗首发精神病（FEP）的最佳管理方法，但药物依从性差仍然是精神病治疗中未满足的主要需求。在这方面，已经假设了 FEP 患者的洞察力和依从性之间存在相互作用，但由于多种陷阱，这种假设受到了挑战。
使用潜在剖面分析和轨迹建模技术来评估 331 名参与为期 3 年的专门早期精神病学计划的 FEP 患者的洞察力和依从性。使用贝叶斯模型比较方法比较研究终点时临床、功能和社会经济结局的评分。
将近三分之一的患者在整个项目期间保持高水平的洞察力和依从性。在 3 年随访结束时，超过四分之三的患者被认为对药物治疗有依从性。在项目开始时洞察力和依从性水平较低的患者首先在依从性方面有所改善，然后在洞察力方面有所改善。此外，具有高洞察力和依从性的患者最有可能达到功能恢复，并体验到环境生活质量的提高。
可以根据洞察力和依从性确定潜在的 FEP 亚群。药物依从性是第一个改善的变量，但洞察力的提高可能在增强依从性方面发挥作用。
