Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland.
School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
Acta Psychiatr Scand. 2023 Mar;147(3):257-266. doi: 10.1111/acps.13498. Epub 2022 Sep 14.
Mood stabilizers (MS) are often used as adjunctive medication in patients with schizophrenia. The aim of this study was to investigate the real-world effectiveness of MS use in persons with schizophrenia.
The study cohort included all persons treated in inpatient care due to schizophrenia during 1972-2014 in Finland (N = 61,889). Drug purchase data were obtained from the national Prescription register and modeled with the PRE2DUP method. The follow-up period covered the years 1996-2017. Mood stabilizers included carbamazepine, valproic acid, lamotrigine, and lithium. The main outcome was psychosis hospitalization. We utilized within-individual design to compare the risk of outcome between time-periods of MS use and non-use within the same person. Stratified Cox regression analyses were conducted with adjusted hazard ratios (aHR) and 95% confidence intervals (CIs).
Mean age at cohort entry was 46.2 years (SD 16.0) and 50.3% were male. During the follow-up (maximum of 22 years, median 14.8 years, interquartile range 7.5-22.0), 28.1% (N = 17,370) of the study cohort used MS, valproic acid being the most often used one (60.4%, N = 10,483). Risk of psychosis hospitalization was lower during MS use than non-use (aHR 0.88, 95% CI 0.86-0.90). Use of lithium (0.84, 0.81-0.87), valproic acid (0.87, 0.85-0.90), and lamotrigine (0.90, 0.85-0.95) were associated with lower risk of psychosis hospitalization compared with their non-use, whereas carbamazepine use was not.
Mood stabilizers were relatively often used as adjunctive treatments in schizophrenia and their use was associated with a 12% decreased risk of psychosis rehospitalization, a marker of relapse in schizophrenia.
心境稳定剂（MS）常被用作精神分裂症患者的辅助药物。本研究旨在调查精神分裂症患者使用 MS 的真实疗效。
研究队列包括 1972 年至 2014 年期间在芬兰因精神分裂症住院治疗的所有患者（n=61889）。药物购买数据来自国家处方登记处，并采用 PRE2DUP 方法建模。随访期涵盖 1996 年至 2017 年。心境稳定剂包括卡马西平、丙戊酸、拉莫三嗪和锂。主要结局是精神病住院。我们利用个体内设计，比较同一患者在 MS 使用和非使用时段发生结局的风险。采用分层 Cox 回归分析，调整后的风险比（aHR）及其 95%置信区间（CI）。
入组时的平均年龄为 46.2 岁（标准差 16.0），男性占 50.3%。在随访期间（最长 22 年，中位数 14.8 年，四分位间距 7.5-22.0），研究队列中有 28.1%（n=17370）的患者使用了 MS，丙戊酸的使用最为常见（60.4%，n=10483）。与非使用期相比，MS 使用期的精神病住院风险较低（aHR 0.88，95%CI 0.86-0.90）。与非使用相比，锂（0.84，0.81-0.87）、丙戊酸（0.87，0.85-0.90）和拉莫三嗪（0.90，0.85-0.95）的使用与精神病住院风险降低相关，而卡马西平的使用则不然。
心境稳定剂在精神分裂症中常被用作辅助治疗，其使用与精神病再住院风险降低 12%相关，这是精神分裂症复发的一个标志。
