Predictors of treatment discontinuation and medication nonadherence in patients recovering from a first episode of schizophrenia, schizophreniform disorder, or schizoaffective disorder: A randomized, double-blind, flexible-dose, multicenter study
Predictors of treatment discontinuation and medication nonadherence in patients recovering from a first episode of schizophrenia, schizophreniform disorder, or schizoaffective disorder: A randomized, double-blind, flexible-dose, multicenter study
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DOI：
10.4088/jcp.v69n0114
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发表时间：
2008-01-01
影响因子：
5.3
通讯作者：
Lieberman, Jeffrey A.
中科院分区：
文献类型：
--
作者：
Perkins, Diana O.;Gu, Hongbin;Lieberman, Jeffrey A.
目的：评估在接受奥氮平、奎替鲁胺或利培酮治疗的首发患者中，违背医嘱停止治疗和药物依从性差的预测因素。方法：首次发作的精神分裂症、精神分裂样障碍或情感性精神障碍（DSM-IV）患者被随机分配接受奥氮平治疗（2.5-20 mg/天）、奎替鲁（100-800 mg/天）或利培酮（0.5-4 mg/天）作为52周、随机、双盲、灵活剂量、多中心研究的一部分。患者于2002年至2004年在美国和加拿大的26个研究中心之一入组。生存分析测试了治疗中止的预测因子，而混合模型测试了药物依从性差的预测因子。显着的调查结果，从最终的模型复制在敏感性analysis.Results：400例随机分配到治疗，115例患者停止治疗，对医疗建议和它9研究完成者进行了比较，在此分析。治疗反应差（p <0.001）和药物依从性低（p = 0.02）是违背医嘱停药的独立预测因素。持续的药物滥用、持续的抑郁和治疗反应失败显著预测药物依从性差（p <0.01）。基线时较高的认知能力和种族（黑人）也与较低的药物依从性相关（p
Objective: To evaluate predictors of treatment discontinuation against medical advice and poor medication adherence among first-episode patients treated with olanzapine, quetiapine, or risperidone.Method: First-episode patients with schizophrenia, schizophreniform disorder, or schizoaffective disorder (DSM-IV) were randomly assigned to olanzapine (2.5-20 rng/day), quetiapine (100-800 mg/day), or risperidone (0.5-4 mg/day) as part of a 52-week, randomized, double-blind, flexible-dose, multicenter study. Patients were enrolled from 2002 to 2004 at one of 26 sites in the United States and Canada. Survival analysis tested for predictors of treatment discontinuation against medical advice, while mixed models tested for predictors of poor medication adherence. Significant findings from the final models were replicated in sensitivity analyses.Results: Of the 400 patients randomly assigned to treatment, 115 patients who discontinued treatment against medical advice and It 9 study completers were compared in this analysis. Poor treatment response (p < .001) and low medication adherence (p = .02) were independent predictors of discontinuation against medical advice. Ongoing substance abuse, ongoing depression, and treatment response failure significantly predicted poor medication adherence (p < .01). Higher cognitive performance at baseline and ethnicity (black) were also associated with lower medication adherence (p