Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Finland.
Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, The Netherlands; School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, The Netherlands; and Second Opinion Outpatient Clinic, GGNet Mental Health, The Netherlands.
Br J Psychiatry. 2022 Dec;221(6):758-765. doi: 10.1192/bjp.2022.117.
Research on the effectiveness of pharmacotherapies for schizophrenia and comorbid substance use disorder (SUD) is very sparse, and non-existent on the prevention of the development of SUDs in patients with schizophrenia.
To compare the real-world effectiveness of antipsychotics in schizophrenia in decreasing risk of developing an initial SUD, and psychiatric hospital admission and SUD-related hospital admission among patients with an SUD.
Two independent national cohorts including all persons diagnosed with schizophrenia ( = 45 476) were followed up for 22 (Finland: 1996-2017) and 11 (Sweden: 2006-2016) years. Risk of developing an SUD was calculated with between-individual models, and risks of psychiatric and SUD-related hospital admission were calculated with within-individual models, using Cox regression and adjusted hazard ratios (aHRs) for using versus not using certain antipsychotics.
For patients with schizophrenia without an SUD, clozapine use (Finland: aHR 0.20, 95% CI 0.16-0.24, < 0.001; Sweden: aHR 0.35, 95% CI 0.24-0.50, < 0.001) was associated with lowest risk of developing an initial SUD in both countries. Antipsychotic polytherapy was associated with second lowest risk (aHR 0.54, 95% CI 0.44-0.66) in Sweden, and third lowest risk (aHR 0.47, 95% CI 0.42-0.53) in Finland. Risk of relapse (psychiatric hospital admission and SUD-related hospital admission) were lowest for clozapine, antipsychotic polytherapy and long-acting injectables in both countries. Results were consistent across both countries.
Clozapine and antipsychotic polytherapy are most strongly associated with reduced risk of developing SUDs among patients with schizophrenia, and with lower relapse rates among patients with both diagnoses.
精神分裂症合并共病物质使用障碍（SUD）的药物治疗效果研究非常匮乏，对于精神分裂症患者 SUD 发展的预防更是没有相关研究。
比较精神分裂症患者使用不同抗精神病药物对降低 SUD 初发风险的实际效果，以及对 SUD 患者的精神科住院和 SUD 相关住院的影响。
纳入两个独立的全国性队列，共包含 45476 名被诊断为精神分裂症的患者，随访时间分别为 22 年（芬兰：1996-2017 年）和 11 年（瑞典：2006-2016 年）。采用个体间模型计算 SUD 发病风险，采用个体内模型计算精神科住院和 SUD 相关住院的风险，采用 Cox 回归和调整后的危险比（aHR）来评估使用和不使用特定抗精神病药物的情况。
对于无 SUD 的精神分裂症患者，氯氮平治疗（芬兰：aHR 0.20，95%CI 0.16-0.24，<0.001；瑞典：aHR 0.35，95%CI 0.24-0.50，<0.001）与两国 SUD 初发风险最低相关。抗精神病药物联合治疗与第二低的风险（aHR 0.54，95%CI 0.44-0.66）相关，与第三低的风险（aHR 0.47，95%CI 0.42-0.53）相关。氯氮平、抗精神病药物联合治疗和长效注射剂在两国的复发（精神科住院和 SUD 相关住院）风险最低。两国的结果一致。
氯氮平和抗精神病药物联合治疗与精神分裂症患者 SUD 风险降低最相关，与两种诊断患者的复发率降低最相关。
