Division of Psychiatry, Haukeland University Hospital, Sandviksleitet 1, N-5035 Bergen, Norway; NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.
Division of Psychiatry, Haukeland University Hospital, Sandviksleitet 1, N-5035 Bergen, Norway; NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Postbox 7804, N-5020 Bergen, Norway.
Gen Hosp Psychiatry. 2023 Jul-Aug;83:185-193. doi: 10.1016/j.genhosppsych.2023.05.003. Epub 2023 May 8.
Drug use is prevalent in patients with schizophrenia spectrum disorders (SSD) but there is limited knowledge about the influence of drug use on the effectiveness of antipsychotic medication. This secondary explorative study compared the effectiveness of three antipsychotics in patients with SSD, with and without drug use.
The BeSt InTro multi-centre, head to head, rater-blinded randomised study compared amisulpride, aripiprazole and olanzapine over a 1-year follow-up period. All patients (n = 144) were aged ≥18 years and met the ICD-10 criteria for SSD (F20-29). Clinical symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). The primary outcome was reduction of a PANSS positive subscale score.
At baseline, 38% of all patients reported drug use in the last 6 months before inclusion, with cannabis as the main drug (85%), followed by amphetamine-type stimulants (45%), sedatives (26%), hallucinogens (19%), cocaine (13%), opiates (4%), GHB (4%), solvents (4%), analgesics (4%) and anabolic steroids (2%). The predominant pattern was the use of several drugs. There were no significant overall differences in the PANSS positive subscale score reduction for the three studied antipsychotics among patients either with or without drug use. In the drug use group, older patients treated with amisulpride showed a greater PANSS positive subscale score reduction during the treatment period compared to younger patients.
The current study showed that drug use does not appear to affect the overall effectiveness of amisulpride, aripiprazole and olanzapine in patients with SSD. However, amisulpride may be a particularly suitable choice for older patients with drug use.
精神分裂症谱系障碍（SSD）患者中药物滥用较为普遍，但关于药物使用对抗精神病药物疗效的影响知之甚少。本二次探索性研究比较了 SSD 患者在使用和不使用药物的情况下三种抗精神病药物的疗效。
BeSt InTro 多中心、头对头、评估者盲法随机研究比较了氨磺必利、阿立哌唑和奥氮平，随访时间为 1 年。所有患者（n=144）年龄≥18 岁，符合 ICD-10 SSD 标准（F20-29）。采用阳性和阴性综合征量表（PANSS）评估临床症状。主要结局是 PANSS 阳性量表评分的降低。
在基线时，所有患者中有 38%在纳入前的过去 6 个月内报告了药物使用，主要药物为大麻（85%），其次为苯丙胺类兴奋剂（45%）、镇静剂（26%）、致幻剂（19%）、可卡因（13%）、阿片类药物（4%）、GHB（4%）、溶剂（4%）、镇痛药（4%）和合成代谢类固醇（2%）。主要的使用模式是同时使用多种药物。在使用和不使用药物的患者中，三种研究抗精神病药物的 PANSS 阳性量表评分降低没有总体差异。在药物使用组中，与年轻患者相比，使用氨磺必利的老年患者在治疗期间的 PANSS 阳性量表评分降低更大。
本研究表明，药物使用似乎不会影响 SSD 患者使用氨磺必利、阿立哌唑和奥氮平的总体疗效。然而，对于有药物使用的老年患者，氨磺必利可能是一个特别合适的选择。
