Shakir Mushde, van Harten Peter N, Hoogendoorn Adriaan W, Willems Anne E, Tenback Diederik E
Veldzicht Center for Transcultural Psychiatry, Custodial Institutions Agency (DJI), Ministry of Justice and Security, Balkbrug, the Netherlands; Parnassia Group Mental Health Service, Den Haag, the Netherlands; Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience, Faculty Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience, Faculty Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; GGZ Centraal Mental Health Service, Amersfoort, the Netherlands.
Schizophr Res. 2024 Dec;274:105-112. doi: 10.1016/j.schres.2024.09.007. Epub 2024 Sep 16.
This study examined the effects of switching antipsychotic polypharmacy (APP) to antipsychotic monotherapy (APM) on various side effects in inpatients with schizophrenia. Side effects of interest included psychic, autonomic, and sexual symptoms, as well as metabolic side effects and movement disorders.
A 9-month parallel randomized open-label clinical trial was conducted involving 136 chronic inpatients from two psychiatric hospitals in the Netherlands. Participants were randomly assigned to either a STAY or a SWITCH group. The SWITCH group underwent a 3-month tapering-off period in which either first-generation or second-generation antipsychotic medication was discontinued, followed by APM. Patients were assessed at baseline and at follow-up assessments at 3, 6, and 9 months. Psychic, neurological, autonomic, and sexual side effects were evaluated using the UKU Rating Scale, while movement disorders were measured with the St. Hans Rating Scale. Various metabolic parameters were also recorded.
In the STAY group, side effects remained generally stable over time, except for a slight reduction in sexual desire. In contrast, the SWITCH group experienced significant reductions in psychic and autonomic symptoms, as well as improvements in akathisia, parkinsonism, and dyskinesia. There were no changes in dystonia, paresthesia, epilepsy, or sexual symptoms for this group. Notably, the SWITCH group also showed significant reductions in BMI and body weight.
Switching APP to APM in long-term inpatients reduces the severity of various side effects, including movement disorders and metabolic side effects.
本研究探讨了将抗精神病药物联合治疗（APP）转换为抗精神病药物单一治疗（APM）对精神分裂症住院患者各种副作用的影响。关注的副作用包括精神症状、自主神经症状和性症状，以及代谢副作用和运动障碍。
进行了一项为期9个月的平行随机开放标签临床试验，涉及荷兰两家精神病医院的136名慢性住院患者。参与者被随机分配到维持组或转换组。转换组经历了一个为期3个月的逐渐减量期，在此期间停用第一代或第二代抗精神病药物，随后采用APM。在基线以及3个月、6个月和9个月的随访评估时对患者进行评估。使用UKU评定量表评估精神、神经、自主神经和性副作用，同时用圣汉斯评定量表测量运动障碍。还记录了各种代谢参数。
在维持组中，除性欲略有下降外，副作用总体上随时间保持稳定。相比之下，转换组的精神和自主神经症状显著减轻，静坐不能、帕金森症和运动障碍也有所改善。该组的肌张力障碍、感觉异常、癫痫或性症状没有变化。值得注意的是，转换组的体重指数（BMI）和体重也显著降低。
将长期住院患者的APP转换为APM可降低包括运动障碍和代谢副作用在内的各种副作用的严重程度。
