在使用氨磺必利、阿立哌唑或奥氮平治疗的精神分裂谱系障碍患者中获得的临床洞察力：一项半随机试验。

Clinical insight among persons with schizophrenia spectrum disorders treated with amisulpride, aripiprazole or olanzapine: a semi-randomised trial.

机构信息

Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.

Department of Clinical Medicine, University of Bergen, Bergen, Norway.

出版信息

BMC Psychiatry. 2023 Jun 29;23(1):482. doi: 10.1186/s12888-023-04981-9.

DOI:10.1186/s12888-023-04981-9

PMID:37386462

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10311854/

Abstract

BACKGROUND

Antipsychotic treatment may improve clinical insight. However, previous studies have reported inconclusive findings on whether antipsychotics improve insight over and above the reduction in symptoms of psychosis. These studies assessed homogeneous samples in terms of stage of illness. Randomised studies investigating a mixed population of first- and multiepisode schizophrenia spectrum disorders might clarify this disagreement.

METHODS

Our data were derived from a pragmatic, rater-blinded, semi-randomised trial that compared the effectiveness of amisulpride, aripiprazole and olanzapine. A sample of 144 patients with first- or multiepisode schizophrenia spectrum disorders underwent eight assessments during a 1-year follow-up. Clinical insight was assessed by item General 12 from the Positive and Negative Syndrome Scale (PANSS). We analysed latent growth curve models to test if the medications had a direct effect on insight that was over and above the reduction in total psychosis symptoms. Furthermore, we investigated whether there were differences between the study drugs in terms of insight.

RESULTS

Based on allocation analysis, all three drugs were associated with a reduction in total psychosis symptoms in the initial phase (weeks 0-6). Amisulpride and olanzapine were associated with improved insight over and above what was related to the reduction in total psychosis symptoms in the long-term phase (weeks 6-52). However, these differential effects were lost when only including the participants that chose the first drug in the randomisation sequence. We found no differential effect on insight among those who were antipsychotic-naïve and those who were previously medicated with antipsychotics.

CONCLUSIONS

Our results suggest that antipsychotic treatment improves insight, but whether the effect on insight surpasses the effect of reduced total psychosis symptoms is more uncertain.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01446328, 05.10.2011.

摘要

背景

抗精神病药物治疗可能会改善临床洞察力。然而，以前的研究报告对抗精神病药物是否能在改善精神病症状的基础上进一步改善洞察力的结论并不一致。这些研究根据疾病的阶段评估了同质的样本。对首发和反复发作的精神分裂症谱系障碍混合人群进行随机研究可能会澄清这一分歧。

方法

我们的数据来自一项实用的、评估者盲法、半随机试验，该试验比较了氨磺必利、阿立哌唑和奥氮平的疗效。144 名首发或反复发作的精神分裂症谱系障碍患者在 1 年的随访中接受了 8 次评估。临床洞察力通过阳性和阴性症状量表（PANSS）的一般项目 12 来评估。我们分析了潜在的增长曲线模型，以测试这些药物是否对洞察力有直接影响，这种影响超过了总精神病症状的减轻。此外，我们还研究了这些研究药物在洞察力方面是否存在差异。

结果

根据分配分析，所有三种药物在初始阶段（第 0-6 周）都与总精神病症状的减轻有关。氨磺必利和奥氮平与长期阶段（第 6-52 周）总精神病症状减轻相关的洞察力改善有关。然而，当仅包括在随机序列中选择第一种药物的参与者时，这些差异效应就消失了。我们没有发现抗精神病药物初治患者和之前使用过抗精神病药物的患者在洞察力方面的差异效应。