NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen 5036, Norway; Department of Clinical Medicine, University of Bergen, Bergen 5007, Norway; TIPS-Network for Clinical Research in Psychosis, Clinic For Adult Mental Health, Stavanger University Hospital, Stavanger 4011, Norway.
NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen 5036, Norway; Department of Clinical Medicine, University of Bergen, Bergen 5007, Norway.
Schizophr Res. 2024 Sep;271:9-18. doi: 10.1016/j.schres.2024.06.047. Epub 2024 Jul 14.
Schizophrenia is a serious mental disorder, and monitoring remission is a widely used measure of effectiveness of the treatment provided. It is very important to identify possible factors correlating with remission. In our substudy of BeSt InTro, a randomized controlled trial of three antipsychotic drugs, 126 patients with ICD-10 diagnoses F20-29 (F23 excluded) were randomized to one of the second-generation antipsychotic drugs amisulpride, aripiprazole or olanzapine. Remission rate was calculated at seven assessment points, with and without using the time criterion of six months included in the consensus remission criteria. Because of drop-out (n = 77), we had data for 49 patients at one-year follow-up. These data were used to calculate the one-year remission rate to 55 % (27/49), without taking into consideration the 6-month time criterion. When we applied the consensus remission criteria with the 6-month time criterion included, the one-year remission rate was calculated for 59 patients: 29 % (17/59). Antipsychotic drug naivety and low negative symptom load at baseline correlated highly with belonging to the remission group. Use of amisulpride was more probable to lead to remission than that of aripiprazole, but it was not more probable than the use of olanzapine (in per-protocol analyses). Negative symptoms showed the largest resistance to treatment. The lack of remission for the majority of the participants in this closely monitored antipsychotic drug trial is alarming and could act as a reminder that novel treatment principles are needed, especially targeted towards the negative symptoms in schizophrenia.
精神分裂症是一种严重的精神障碍，监测缓解是评估治疗效果的常用方法。确定与缓解相关的可能因素非常重要。在 BeSt InTro 的子研究中，这是一项针对三种抗精神病药物的随机对照试验，126 名符合 ICD-10 诊断 F20-29（排除 F23）的患者被随机分配至第二代抗精神病药物氨磺必利、阿立哌唑或奥氮平组。在七个评估点计算缓解率，包括和不包括共识缓解标准中六个月的时间标准。由于脱落（n=77），我们在一年随访时获得了 49 名患者的数据。这些数据用于计算一年缓解率为 55%（27/49），不考虑 6 个月的时间标准。当我们应用包括 6 个月时间标准的共识缓解标准时，59 名患者的一年缓解率为 29%（17/59）。抗精神病药物初治和基线时较低的阴性症状负荷与属于缓解组高度相关。氨磺必利治疗更可能导致缓解，而阿立哌唑治疗则不太可能，奥氮平治疗也不太可能（按方案分析）。阴性症状对治疗的抵抗力最大。在这项密切监测的抗精神病药物试验中，大多数参与者没有缓解，这令人震惊，可能提醒我们需要新的治疗原则，特别是针对精神分裂症的阴性症状。
