Comparison of Treatment Response in Second-Episode Versus First-Episode Schizophrenia
Comparison of Treatment Response in Second-Episode Versus First-Episode Schizophrenia
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DOI：
10.1097/jcp.0b013e31827bfcc1
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发表时间：
2013-02-01
影响因子：
2.9
通讯作者：
Martinez, Lupe
中科院分区：
文献类型：
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作者：
Emsley, Robin;Oosthuizen, Petrus;Martinez, Lupe
本研究旨在探讨精神分裂症复发后是否会出现疾病进展和治疗无效。我们比较了一个队列的结果与标准化协议的第一次和第二次发作的疾病。样本包括31名参与者，他们（1）成功完成了为期2年的利培酮长效注射剂（RLAI）治疗精神分裂症首次发作的开放标签治疗期;（2）经历了长达3年或直至复发的间歇性治疗扩展期，（3）进入了为期2年的RLAI治疗复发期。对于继续接受治疗的患者（n = 14 [45%]），2个治疗阶段的阳性和阴性症状量表评分降低、应答率、缓解率、至应答时间、至缓解时间、功能结局评分和模态RLAI剂量相似。然而，31例患者中有17例（55%）在第二次发作时中止研究，而50例患者中有14例（28%）在第一次发作时中止研究，表明疾病复发后重新使用抗精神病药物的有效性降低。最值得注意的是，在5名参与者（16%）中观察到紧急治疗无反应，这与复发可能在一部分患者中具有生物学危害的假设一致。
This study investigated whether illness progression and treatment refractoriness emerge after relapse in schizophrenia. We compared outcomes in a cohort treated with a standardized protocol for the first and second episodes of illness. The sample comprised 31 participants who (1) had successfully completed a 2-year open-label treatment phase with risperidone long-acting injection (RLAI) for a first episode of schizophrenia; (2) underwent an intermittent treatment extension phase up to 3 years or until recurrence, and (3) entered a further 2-year treatment phase with RLAI for a recurrence episode. For the patients who remained in treatment (n = 14 [45%]), Positive and Negative Syndrome Scale score reductions, response rates, remission rates, time to response, time to remission, functional outcome scores, and modal RLAI doses were similar for the 2 treatment periods. However, 17 (55 %) of the 31 patients discontinued the study in the second episode compared with 14 (28%) of 50 patients in the first episode, suggesting reduced effectiveness of antipsychotics when reintroduced after illness recurrence. Most notably, emergent treatment nonresponsiveness was observed in 5 participants (16%), consistent with the hypothesis that relapse may be biologically harmful in a subset of patients.