Do all schizophrenia patients need antipsychotic treatment continuously throughout their lifetime? A 20-year longitudinal study
Do all schizophrenia patients need antipsychotic treatment continuously throughout their lifetime? A 20-year longitudinal study
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DOI：
10.1017/s0033291712000220
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发表时间：
2012-10-01
影响因子：
6.9
通讯作者：
Faull, R. N.
中科院分区：
文献类型：
--
作者：
Harrow, M.;Jobe, T. H.;Faull, R. N.
背景。该领域的主流护理标准涉及对所有精神分裂症患者长期使用抗精神病药物的重要性的背景假设。然而，是否所有SZ患者都需要无限期的抗精神病药物？是否有一些因素有助于确定哪些SZ患者可以在不服用抗精神病药物的情况下进入长时间的康复期？本研究对这些问题进行了20年的纵向研究。来自芝加哥随访研究的139名早期年轻精神病患者，包括70名SZ综合征患者和69名情绪障碍患者，在急性期进行了前瞻性评估，然后在接下来的20年里随访了6次。用标准化的工具评估患者的主要症状、心理社会功能、人格、态度变量、神经认知和治疗。在每次随访中，30-40%的SZ患者不再服用抗精神病药物。从4.5年的随访开始并继续随访，SZ患者长期不服用抗精神病药物的可能性显著降低，并且经历了更多的恢复期；他们也有更多有利的风险和保护因素。长期停用抗精神病药物的SZ患者复发的频率并不高。数据表明，并非所有SZ患者一生都需要持续使用抗精神病药物治疗。长期不服用抗精神病药物的SZ患者是一个自我选择的群体，具有更好的内部资源和更大的弹性。他们有更好的预后因素，更好的病前发育成就，更不容易焦虑，更好的神经认知技能，更不容易患精神病，经历更长的恢复期。
Background. The prevailing standard of care in the field involves background assumptions about the importance of prolonged use of antipsychotic medications for all schizophrenia (SZ) patients. However, do all SZ patients need antipsychotics indefinitely? Are there factors that help to identify which SZ patients can enter into prolonged periods of recovery without antipsychotics? This 20-year longitudinal research studied these issues.Method. A total of 139 early young psychotic patients from the Chicago Follow-up Study, including 70 patients with SZ syndromes and 69 with mood disorders, were assessed, prospectively, at the acute phase and then followed up six times over the next 20 years. Patients were assessed with standardized instruments for major symptoms, psychosocial functioning, personality, attitudinal variables, neurocognition and treatment.Results. At each follow-up, 30-40% of SZ patients were no longer on antipsychotics. Starting at the 4.5-year follow-ups and continuing thereafter, SZ patients not on antipsychotics for prolonged periods were significantly less likely to be psychotic and experienced more periods of recovery; they also had more favorable risk and protective factors. SZ patients off antipsychotics for prolonged periods did not relapse more frequently.Conclusions. The data indicate that not all SZ patients need treatment with antipsychotics continuously throughout their lives. SZ patients not on antipsychotics for prolonged periods are a self-selected group with better internal resources associated with greater resiliency. They have better prognostic factors, better pre-morbid developmental achievements, less vulnerability to anxiety, better neurocognitive skills, less vulnerability to psychosis and experience more periods of recovery.