Adding or switching antipsychotic medications in treatment-refractory schizophrenia.
Adding or switching antipsychotic medications in treatment-refractory schizophrenia.
复制标题
在难治性精神分裂症中添加或更换抗精神病药物。
DOI：
10.1176/ps.2007.58.7.983
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
Olfson,Mark
中科院分区：
文献类型：
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作者：
Kreyenbuhl,Julie;Marcus,StevenC;West,JoyceC;Wilk,Joshua;Olfson,Mark
目的：这项研究比较了精神分裂症患者的抗精神病药物转换为管理难治性阳性精神病症状与那些增加了另一种抗精神病药物的患者。精神科医生的特点和看法的药物治疗的变化对临床outcomes.Methods的有效性也报道：精神科医生参加了一个全国代表性的邮寄调查（N= 209）报告的临床特征，管理，并在抗精神病药物（添加与切换）的一个成年患者的治疗难治性精神分裂症的变化，他们的照顾至少一年的反应。结果：33%的患者接受了额外的抗精神病药物治疗。与转换了抗精神病药物的患者相比，那些增加了抗精神病药物的患者更有可能是女性，接受同一精神病医生的治疗超过两年，并且最近被开了抗抑郁药。与精神科医生转换抗精神病药物处方相比，那些添加抗精神病药物的人报告说，这种变化不太可能减少阳性症状，改善功能，并防止住院。精神科医生谁添加，而不是切换抗精神病药物报告更频繁地参加由制药公司赞助的教育计划。结论：与其他研究和实践指南的建议一致，精神科医生认为抗精神病药物多药治疗对治疗抵抗性阳性精神病症状通常是无效的策略。鉴于这些发现，应努力确定和实施更有效的循证药理学方法。（精神病学服务58：983-990，2007）
Objective: This study compared patients with schizophrenia whose an-tipsychotic medications were switched to manage treatment-resistant positive psychotic symptoms with those for whom another antipsychotic was added. Psychiatrists’ characteristics and perceptions of effectiveness of the medication change on clinical outcomes were also reported.Methods: Psychiatrists participating in a nationally representative mailed survey (N= 209) reported on the clinical features, management, and response to the change in antipsychotic medication (added versus switched) of one adult patient with treatment-refractory schizophrenia under their care for at least one year. Results: Thirty-three percent of patients were treated with an added antipsychotic medication. Compared with patients whose antipsychotic medications were switched, those with an added antipsychotic medication were more likely to be female, to have received care from the same psychiatrist for more than two years, and to have been recently prescribed an antidepressant. Compared with psychiatrists who switched antipsychotic prescriptions, those who added an antipsychotic reported that the change was less likely to reduce positive symptoms, improve functioning, and prevent hospitalization. Psychiatrists who added rather than switched antipsychotics reported more frequent attendance at educational programs sponsored by a pharmaceutical company. Conclusions: Consistent with other lines of research and practice guideline recommendations, psychiatrists perceive antipsychotic polypharmacy to be a generally ineffective strategy for treatment-resistant positive psychotic symptoms. In light of these findings, efforts to identify and implement more effective evidence-based pharmacologic approaches should be undertaken.(Psychiatric Services 58: 983–990, 2007)