持续多巴胺D2受体阻塞和第一次精神分裂症的长期结果
Jari Tiihonen1, Antti Tanskanen1, Marco Solmi1
1Department of Forensic Psychiatry, University of Eastern Finland, and Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm (Tiihonen, Tanskanen, Taipale); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen, Tanskanen, Taipale); SCIENCES Lab and Department of Psychiatry, University of Ottawa, Ottawa (Solmi); On Track: The Champlain First Episode Psychosis Program, and Regional Centre for the Treatment of Eating Disorders, Department of Mental Health, Ottawa Hospital, Ottawa (Solmi); Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (Solmi); Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, Berlin (Solmi, Correll); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY (Rubio, Correll, Kane); Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY (Rubio, Correll, Kane); Institute for Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY (Rubio, Kane); German Center for Mental Health, partner site Berlin (Correll); School of Pharmacy, University of Eastern Finland, Kuopio (Taipale).
尽管持续阻断多巴胺D2受体,但大约40%-50%的第一发精神分裂症患者复发. 长期的D2阻塞不会增加突破性精神病的风险,这表明疾病复发中的非多巴胺基因因素.
科学领域:
- 精神病学是一个精神病学.
- 神经科学是一个神经科学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 尽管持续存在多巴胺D2受体阻断,但第一发作精神分裂症复发率尚未得到充分证实.
- 长期使用D2阻断抗精神病药物在突破性精神病中的作用尚不清楚.
研究的目的:
- 调查尽管持续D2阻塞,但复发的患者比例.
- 为了测试突破性精神病发病率是否会在持续的D2抗剂治疗下加快超过5年,在第一次精神分裂症中.
主要方法:
- 利用芬兰全国范围的第一发精神分裂症患者队列 (年龄 ≤45岁).
- 分析了1996-2014年的数据,重点关注持续的长效注射抗精神病药物治疗.
- 主要结局:严重复发导致住院;次要结局:复发发病率比率 (IRR).
主要成果:
- 在305名持续治疗LAI的患者中,有45%的患者在10年内复发.
- 随着时间的推移,每年复发发病率显著下降,与1年相比,6-10年内IRR为0.12,与1年相比.
- 长期的D2阻塞与突破性精神病的风险增加无关.
结论:
- 40%-50%的第一发精神分裂症患者在持续的D2阻塞下复发.
- 复发似乎受到精神分裂症病理生理学的非多巴胺基因方面的影响.
- 长期的D2受体阻塞不会增加突破性精神病的风险.
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