Effects of antipsychotic medications on psychosocial functioning in patients with chronic schizophrenia: findings from the NIMH CATIE study.
Effects of antipsychotic medications on psychosocial functioning in patients with chronic schizophrenia: findings from the NIMH CATIE study.
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DOI：
10.1176/ajp.2007.164.3.428
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发表时间：
2007-03
期刊：
影响因子：
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通讯作者：
M. Swartz;D. Perkins;T. Stroup;S. Davis;G. Capuano;R. Rosenheck;F. Reimherr;M. McGee;R. Keefe-R.
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文献类型：
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作者：
M. Swartz;D. Perkins;T. Stroup;S. Davis;G. Capuano;R. Rosenheck;F. Reimherr;M. McGee;R. Keefe-R.
目的本研究旨在探讨第二代抗精神病药物和较老的代表性药物对慢性精神分裂症患者心理社会功能的相对影响。方法：入选NIMH临床抗精神病药物干预有效性试验（CATIE）项目的患者。在第一阶段，患者被随机分配接受奥氮平，奋乃静，奎替利，利培酮，齐拉西酮，长达18个月。在因无效而中止第1阶段治疗后选择该途径的患者纳入氯氮平治疗;所有其他患者均接受另一种第二代抗精神病药治疗。使用生活质量量表评估心理社会功能。结果1期患者中有三分之一达到主要生活质量量表分析终点12个月（平均效应量0.19 SD单位）的患者的心理社会功能适度改善。尽管几种药物单独与基线相比有显著变化，但总体而言，不同药物之间无显著差异。6个月和18个月时的结果相似。在6、12或18个月时，治疗组之间的生活质量量表总分或子量表评分的变化量无显著差异。在疗效路径中接受氯氮平治疗的患者取得了类似的获益。早期停止治疗，尤其是在基线时受损最严重的患者中，限制了实现更实质性功能改善的能力。结论：所有抗精神病药物治疗组在所有阶段的心理社会功能都有适度改善。在6、12或18个月后，它们之间没有差异。要取得更大的改善，可能需要更密集的连续性心理社会康复干预措施。
OBJECTIVE This study examined the relative effects of the second-generation antipsychotic drugs and an older representative agent on psychosocial functioning in patients with chronic schizophrenia. METHOD Consenting patients were enrolled in the NIMH Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) project. In phase 1, patients were randomly assigned to receive olanzapine, perphenazine, quetiapine, risperidone, or ziprasidone for up to 18 months. Clozapine was included for patients who chose this pathway after discontinuing phase 1 due to inefficacy; all other patients received another second-generation antipsychotic. Psychosocial functioning was assessed using the Quality of Life Scale. RESULTS Psychosocial functioning modestly improved for the one-third of phase 1 patients who reached the primary Quality of Life Scale analysis endpoint of 12 months (average effect size 0.19 SD units). Although for several of the drugs individually there were significant changes from baseline, overall there were no significant differences between the different agents. Results were similar at 6 and 18 months. There were no significant differences among the treatment groups in the amount of change in the Quality of Life Scale total score or subscale scores at 6, 12, or 18 months. Patients treated with clozapine in the efficacy pathway made comparable gains. Early treatment discontinuations, especially among patients most impaired at baseline, limited the ability to achieve more substantial functional gains. CONCLUSIONS All antipsychotic treatment groups in all phases made modest improvements in psychosocial functioning. There were no differences among them after 6, 12, or 18 months. More substantial improvements would likely require more intensive adjunctive psychosocial rehabilitation interventions.