Prescription Practices in the Treatment of First-Episode Schizophrenia Spectrum Disorders: Data From the National RAISE-ETP Study
Prescription Practices in the Treatment of First-Episode Schizophrenia Spectrum Disorders: Data From the National RAISE-ETP Study
复制标题
DOI：
10.1176/appi.ajp.2014.13101355
复制
发表时间：
2015-03-01
影响因子：
17.7
通讯作者：
Kane, John M.
中科院分区：
文献类型：
--
作者：
Robinson, Delbert G.;Schooler, Nina R.;Kane, John M.
目的：治疗指南建议对首发和多发精神分裂症患者采取不同的药物治疗策略。为了评估社区临床医生在多大程度上调整了他们对首发患者的常规治疗方案，作者在全国早期患者队列中检查了处方模式和与处方选择相关的因素。方法：研究开始时的处方数据是从404名参与精神分裂症初期发作后恢复项目早期治疗计划的参与者中获得的（RAISE-ETP），一项针对首发精神分裂症谱系障碍患者的全国性多中心有效性研究。抗精神病药物治疗不超过6个月，在研究entry.Results：作者确定了159例（39.4%的样本）谁可能受益于他们的精神处方的变化。其中，8.8%接受了高于推荐剂量的推荐抗精神病药物处方; 32.1%接受了奥氮平处方（通常是高剂量），23.3%接受了一种以上的抗精神病药物处方，36.5%接受了一种抗精神病药物和一种抗抑郁药物，但没有明确的适应症，10.1%接受了精神药物，但没有抗精神病药物，1.2%接受了兴奋剂。多变量分析显示，性别，年龄和保险状况对处方实践的影响。在单变量分析中发现了与既往多次发作患者研究中报告的效应一致的种族和民族效应。尽管处方做法存在一些区域差异，但没有一个区域的做法始终与其他区域不同。诊断有限，不一致的effects.Conclusions：除了处方教育，政策制定者可能需要考虑不仅病人的因素，但也提供服务的因素，努力改善首发精神分裂症患者的处方做法。
Objective: Treatment guidelines suggest distinctive medication strategies for first-episode and multiepisode patients with schizophrenia. To assess the extent to which community clinicians adjust their usual treatment regimens for first-episode patients, the authors examined prescription patterns and factors associated with prescription choice in a national cohort of early-phase patients.Method: Prescription data at study entry were obtained from 404 participants in the Recovery After an Initial Schizophrenia Episode Project's Early Treatment Program (RAISE-ETP), a nationwide multisite effectiveness study for patients with first-episode schizophrenia spectrum disorders. Treatment with antipsychotics did not exceed 6 months at study entry.Results: The authors identified 159 patients (39.4% of the sample) who might benefit from changes in their psychotropic prescriptions. Of these, 8.8% received prescriptions for recommended antipsychotics at higher than recommended dosages; 32.1% received prescriptions for olanzapine (often at high dosages), 23.3% for more than one antipsychotic, 36.5% for an antipsychotic and also an antidepressant without a clear indication, 10.1% for psychotropic medications without an antipsychotic, and 1.2% for stimulants. Multivariate analysis showed evidence for sex, age, and insurance status effects on prescription practices. Racial and ethnic effects consistent with effects reported in previous studies of multiepisode patients were found in univariate analyses. Despite some regional variations in prescription practices, no region consistently had different practices from the others. Diagnosis had limited and inconsistent effects.Conclusions: Besides prescriber education, policy makers may need to consider not only patient factors but also service delivery factors in efforts to improve prescription practices for first-episode schizophrenia patients.