奥氮平和精神分裂症治疗.ppt

* * 影响治疗依从性的原因有很多，除了患者本身的因素，环境因素，医生是否重视长期治疗外，与治疗相关的因素更为重要。了解抗精神病药物的治疗总效应这个概念，能有效明确中止治疗的原因。 生活质量量表（ QLS ） 2005年Liu等发表了一篇汇总了四项随机双盲临床研究的荟萃分析报告，这四项临床研究均是治疗24-28周，总计入组了1627例精神分裂症或相关疾病患者，以评估中断治疗与不良预后相关性的汇总分析。结果发现，如果患者在治疗的前2周内PANSS的总分能改善大于20%，那么患者完成研究的概率将大大提高到80%。这意味着早期显效预示患者长期治疗结果更好。 * * Key Points: As previously mentioned, time to treatment discontinuation for any cause has been identified as an important outcome parameter in the medication management of schizophrenia. This study compared five antipsychotics – clozapine (n=90), olanzapine (n=390), risperidone (n=287), quetiapine (n=133), and haloperidol (n=154) – on the time to all-cause discontinuation during the 1 year following its initiation as measured by the number of days on continuous treatment up to the first gap of 14 days. Participants included 1054 new initiators of the 5 antipsychotics in the Schizophrenia Care and Assessment Program (SCAP), a 3-year longitudinal, observational study of schizophrenia. Clozapine and olanzapine-treated patients were on their medication significantly longer than patients receiving risperidone, quetiapine, or haloperidol. Compared with olanzapine, the likelihood of discontinuation was 25%, 54%, and 158% greater among patients receiving risperidone, quetiapine, or haloperidol, respectively. However, the clozapine treatment group was 45% less likely to discontinue medication than olanzapine-treated patients. This suggests that antipsychotics appear to significantly differ in the time to all-cause discontinuation. Longer time to discontinuation was found to be highly correlated with therapeutic efficacy across the studied antipsychotics. The cause of this association will require further investigation. Reference: Zhu B, Ascher-Svanum H, Faries D, Gibson PJ, et al. Differences among antipsychotics in the time to all-cause drug discontinuation: results from a longitudinal naturalistic study of schizophrenia. Presented at IPS 2003; Boston, Massachusetts. * Key Points: