Arango Celso, Fagiolini Andrea, Gorwood Philip, Kane John M, Diaz-Mendoza Sergio, Sahota Navdeep, Correll Christoph U
Hospital General Universitario Gregorio Marañón, Universidad Complutense.
Universita di Siena.
Res Sq. 2023 Mar 8:rs.3.rs-2594278. doi: 10.21203/rs.3.rs-2594278/v1.
Background Schizophrenia is mostly a chronic disorder whose symptoms include psychosis, negative symptoms and cognitive dysfunction. Poor adherence is common and related relapse can impair outcomes. Long-acting injectable antipsychotics (LAIs) may promote treatment adherence and decrease the likelihood of relapse and rehospitalization. Using LAIs in first-episode psychosis (FEP) and early-phase (EP) schizophrenia patients could benefit them, yet LAIs have traditionally been reserved for chronic patients. Methods A three-step modified Delphi panel process was used to obtain expert consensus on using LAIs with FEP and EP schizophrenia patients. A literature review and input from a steering committee of five experts in psychiatry were used to develop statements about patient population, adverse event management, and functional recovery. Recruited Delphi process psychiatrists rated the extent of their agreement with the statements over three rounds (Round 1: paper survey, 1:1 interview; Rounds 2-3: email survey). Analysis rules determined whether a statement progressed to the next round and the level of agreement deemed consensus. Measures of central tendency (mode, mean) and variability (interquartile range) were reported back to help panelists assess their previous responses in the context of those of the overall group. Results The Delphi panelists were 17 psychiatrists experienced in treating schizophrenia with LAIs, practicing in seven countries (France, Italy, US, Germany, Spain, Denmark, UK). Panelists were presented with 73 statements spanning three categories: patient population; medication dosage, management, and adverse events; and functional recovery domains and assessment. Fifty-five statements achieved ≥ 80% agreement (considered consensus). Statements with low agreement (40%-79%) or very low agreement (< 39%) concerned initiating dosage in FEP and EP patients, and managing loss of efficacy and breakthrough episodes, reflecting current evidence gaps. The panel emphasized benefits of LAIs in FEP and EP patients, with consensus that LAIs can decrease the risk of relapse, rehospitalization, and functional dysfunction. The panel supported links between these benefits and multidimensional longer-term functional recovery beyond symptomatic remission. Conclusions Findings from this Delphi panel support the use of LAIs in FEP and EP schizophrenia patients regardless of disease severity, number of relapses, or social support status. Gaps in clinician knowledge make generating evidence on using LAIs in FEP and EP patients critical.
精神分裂症大多是一种慢性疾病，其症状包括精神病性症状、阴性症状和认知功能障碍。依从性差很常见，相关的复发会影响治疗结果。长效注射用抗精神病药物（LAIs）可能会提高治疗依从性，并降低复发和再次住院的可能性。在首发精神病（FEP）和早期阶段（EP）的精神分裂症患者中使用LAIs可能会使他们受益，但传统上LAIs一直保留给慢性患者使用。方法：采用三步改良德尔菲专家小组程序，就FEP和EP精神分裂症患者使用LAIs达成专家共识。通过文献综述以及来自五名精神病学专家组成的指导委员会的意见，制定了关于患者群体、不良事件管理和功能恢复的陈述。招募参与德尔菲程序的精神科医生在三轮评估中对他们对这些陈述的同意程度进行评分（第一轮：纸质调查、一对一访谈；第二至三轮：电子邮件调查）。分析规则确定陈述是否进入下一轮以及被视为达成共识的同意程度。报告集中趋势（众数、均值）和变异性（四分位距）的测量结果，以帮助专家小组成员在整个小组的背景下评估他们之前的回答。结果：德尔菲专家小组成员为17名在七个国家（法国、意大利、美国、德国、西班牙、丹麦、英国）从事使用LAIs治疗精神分裂症工作的精神科医生。专家小组成员收到了73条陈述，涵盖三个类别：患者群体；药物剂量、管理和不良事件；以及功能恢复领域和评估。55条陈述达成了≥80%的同意率（视为达成共识）。同意率较低（40%-79%）或非常低（<39%）的陈述涉及FEP和EP患者的起始剂量，以及疗效丧失和突破性发作的管理，这反映了当前的证据空白。专家小组强调了LAIs对FEP和EP患者的益处，达成的共识是LAIs可以降低复发、再次住院和功能障碍的风险。专家小组支持这些益处与症状缓解之外的多维度长期功能恢复之间的联系。结论：该德尔菲专家小组的研究结果支持在FEP和EP精神分裂症患者中使用LAIs，无论疾病严重程度、复发次数或社会支持状况如何。临床医生知识方面的差距使得获取关于在FEP和EP患者中使用LAIs的证据至关重要。
