An Algorithm-Based Approach to First-Episode Schizophrenia: Response Rates Over 3 Prospective Antipsychotic Trials With a Retrospective Data Analysis
An Algorithm-Based Approach to First-Episode Schizophrenia: Response Rates Over 3 Prospective Antipsychotic Trials With a Retrospective Data Analysis
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DOI：
10.4088/jcp.09m05785yel
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发表时间：
2011-11-01
影响因子：
5.3
通讯作者：
Remington, Gary
中科院分区：
文献类型：
--
作者：
Agid, Ofer;Arenovich, Tamara;Remington, Gary
目的：早期，有效的治疗首发精神分裂症的主张，虽然缺乏证据的基础上系统的方法，多个抗精神病药物试验。采用自然主义设计，我们检查了3个限定的抗精神病药物试验的应答率。方法：在2003年6月至2008年12月期间，根据DSM-IV标准，244名患有首发精神分裂症或情感性精神障碍的个体在加拿大安大略多伦多成瘾和精神健康中心接受治疗，遵循一种算法，使他们通过2项抗精神病药物试验，接着是氯氮平的试验对于前2项试验，治疗包括利培酮，然后是奥氮平，反之亦然;每项试验包括3个阶段（低剂量、全剂量或高剂量），每个水平持续长达4周，并根据缓解/耐受性进行调整。临床应答定义为临床疗效总评量表-改善评分为2分（明显改善）或1分（非常明显改善）和/或简明精神病评定量表思维障碍子量表评分
Objective: Early, effective treatment in first-episode schizophrenia is advocated, although evidence based on a systematic approach over multiple antipsychotic trials is lacking. Employing a naturalistic design, we examined response rates over 3 circumscribed antipsychotic trials.Method: Between June 2003 and December 2008, 244 individuals with first-episode schizophrenia or schizoaffective disorder according to DSM-IV criteria were treated at the Centre for Addiction and Mental Health, Toronto, Ontario, Canada, following an algorithm that moved them through 2 antipsychotic trials, followed by a trial with clozapine. For the first 2 trials, treatment consisted of risperidone followed by olanzapine, or vice versa; each trial consisted of 3 stages (low-, full-, or high-dose) lasting up to 4 weeks at each level and adjusted according to response/tolerability. Clinical response was defined as a Clinical Global Impressions-Improvement score of 2 (much improved) or 1 (very much improved) and/or a Brief Psychiatric Rating Scale Thought Disorder subscale score