Impact of Second-Generation Antipsychotics and Perphenazine on Depressive Symptoms in a Randomized Trial of Treatment for Chronic Schizophrenia
Impact of Second-Generation Antipsychotics and Perphenazine on Depressive Symptoms in a Randomized Trial of Treatment for Chronic Schizophrenia
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DOI：
10.4088/jcp.09m05258gre
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发表时间：
2011-01-01
影响因子：
5.3
通讯作者：
Lieberman, Jeffrey A.
中科院分区：
文献类型：
--
作者：
Addington, Donald E.;Mohamed, Somaia;Lieberman, Jeffrey A.
背景：根据美国精神病学协会精神分裂症临床实践指南，第二代抗精神病药物可能特别适用于精神分裂症抑郁症的治疗。我们利用2001年1月至2004年12月进行的临床抗精神病药物干预有效性试验（CATIE）的数据，研究了这些药物对抑郁症症状的影响。方法：将dsm - iv定义的精神分裂症患者（N=1,460）分配到第一代抗精神病药（奋那嗪）或4种第二代药物（奥氮平、喹硫平、利培酮或齐拉西酮）中的一种治疗，并随访长达18个月（第一阶段）。迟发性运动障碍患者被排除在包括奋那嗪的随机分组之外。用卡尔加里精神分裂症抑郁量表（CDSS）评估抑郁。混合模型用于评估初始指定药物治疗期间的组间差异。相互作用分析通过患者的CDSS基线评分是否为6来评估药物反应的差异，CDSS基线评分表明当前存在重度抑郁发作（MDE）。结果：在1期分析中，治疗组之间没有显着差异，尽管所有治疗组的抑郁症都有显着改善。在治疗和基线MDE之间发现了显著的相互作用（P= 0.05），进一步的配对比较表明奎硫平在基线MDE患者中优于利培酮（P= 0.0056）。结论：我们没有发现任何第二代抗精神病药物和第一代抗精神病药物奋那嗪之间的差异，也不支持临床实践推荐，但我们确实发现了一个信号，表明基线时MDE患者的奎硫平与利培酮之间存在微小的潜在差异。
Background: According to the American Psychiatric Association Clinical Practice Guidelines for schizophrenia, second-generation antipsychotics may be specifically indicated for the treatment of depression in schizophrenia. We examined the impact of these medications on symptoms of depression using the data from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE), conducted between January 2001 and December 2004.Method: Patients with DSM-IV-defined schizophrenia (N=1,460) were assigned to treatment with a first-generation antipsychotic (perphenazine) or one of 4 second-generation drugs (olanzapine, quetiapine, risperidone, or ziprasidone) and followed for up to 18 months (phase 1). Patients with tardive dyskinesia were excluded from the randomization that included perphenazine. Depression was assessed with the Calgary Depression Scale for Schizophrenia (CDSS). Mixed models were used to evaluate group differences during treatment with the initially assigned drug. An interaction analysis evaluated differences in drug response by whether patients had a baseline score on the CDSS of 6, indicative of a current major depressive episode (MDE).Results: There were no significant differences between treatment groups on phase 1 analysis, although there was a significant improvement in depression across all treatments. A significant interaction was found between treatment and experiencing an MDE at baseline (P=.05), and further paired comparisons suggested that quetiapine was superior to risperidone among patients who were in an MDE at baseline (P=.0056).Conclusions: We found no differences between any second-generation antipsychotic and the first-generation antipsychotic perphenazine and no support for the clinical practice recommendation, but we did detect a signal indicating a small potential difference favoring quetiapine over risperidone only in patients with an MDE at baseline.