Hansen Helene Gjervig, Speyer Helene, Stürup Anne Emilie, Hjorthøj Carsten, Öngür Dost, Nordentoft Merete, Albert Nikolai
Copenhagen Research Centre for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Hellerup, Denmark.
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Psychol Med. 2024 Nov 18;54(15):1-11. doi: 10.1017/S0033291724002678.
Short-term exposure to antipsychotics has proven to be beneficial. However, naturalistic studies are lacking regarding the long-term use of antipsychotics. This study aimed to investigate changes in use of antipsychotics over 20 years after a first-episode schizophrenia.
This study is part of the Danish OPUS trial (1998-2000), including 496 participants with first-episode schizophrenia. Participants were reassessed four times over 20 years. The main outcomes were days on medication, redeemed prescriptions of clozapine, psychiatric hospitalizations, and employment.
At the 20-year follow-up, an attrition of 71% was detected. In total, 143 out of 496 participated, with 36% ( = 51) in remission-of-psychotic-symptoms-off-medication. The lowest number of days on medication (mean [s.d.], 339 [538] days) was observed in this group over 20 years. Register data on redeemed antipsychotics were available for all trial participants ( = 416). Individuals in treatment with antipsychotics ( = 120) at the 20-year follow-up had spent significantly more days in treatment (5405 [1857] 1434 [1819] mean days, = 0.00) and more had ever redeemed a prescription of clozapine (25% 7.8%, = 0.00) than individuals who had discontinued antipsychotics ( = 296). Further, discontinuers had significantly higher employment at the 20-year follow-up (28.4% 12.5%, = 0.00).
In a cohort of individuals with first-episode schizophrenia, 36% were in remission-of-psychotic-symptoms-off-medication. However, high attrition was detected, potentially affecting study results by inflating results from individuals with favorable outcomes. From register data, free from attrition, approximately 30% were in treatment with antipsychotics, and 70% had discontinued antipsychotics. Individuals in treatment had the least favorable outcomes, implying greater illness severity.
已证实短期使用抗精神病药物有益。然而，关于抗精神病药物的长期使用缺乏自然主义研究。本研究旨在调查首次发作精神分裂症后20年抗精神病药物使用情况的变化。
本研究是丹麦OPUS试验（1998 - 2000年）的一部分，包括496名首次发作精神分裂症患者。参与者在20年中接受了4次重新评估。主要结局指标为用药天数、氯氮平的配药处方、精神病住院次数和就业情况。
在20年随访时，发现失访率为71%。496名参与者中共有143人参与，其中36%（=51人）在停药后精神病症状缓解。该组在20年中观察到的用药天数最少（均值[标准差]，339[538]天）。所有试验参与者（=416人）都有抗精神病药物配药登记数据。在20年随访时接受抗精神病药物治疗的个体（=120人）的治疗天数显著更多（均值天数为5405[1857] 比停药的个体（=296人）多1434[1819]天，P = 0.00），并且曾经配过氯氮平处方的比例更高（25% 比7.8%，P = 0.00）。此外，停药者在20年随访时的就业率显著更高（28.4% 比12.5%，P = 0.00）。
在首次发作精神分裂症患者队列中，36%在停药后精神病症状缓解。然而，发现失访率较高，可能通过夸大良好结局个体的结果而影响研究结果。从无失访的登记数据来看，约30%的人正在接受抗精神病药物治疗，70%的人已停用抗精神病药物。接受治疗的个体结局最差，这意味着疾病严重程度更高。
