最近治疗和没有治疗的个体的抗精神病急性期治疗:个体参与者数据元分析
Lasse Brandt1,2, Orestis Efthimiou3,4, Spyridon Siafis5,6
1Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
JAMA psychiatry
|May 7, 2025
概括
对精神分裂症症状的抗精神病治疗效果似乎是相似的,无论患者最近是否接受过治疗. 然而,最近没有接受治疗的患者在抗精神病和安慰剂治疗中表现更好.
科学领域:
- 精神病学和临床神经科学
- 精神病的药理治疗 精神病的药理治疗
- 精神分裂症谱系障碍 精神分裂症谱系障碍
背景情况:
- 假设表明抗精神病治疗的疗效可能会根据精神分裂症最近的治疗史有所不同.
- 现有证据比较最近接受治疗与最近未接受治疗的个体的治疗结果是有限的.
- 了解这些差异对于优化急性期治疗策略至关重要.
研究的目的:
- 为了比较急性阶段抗精神病治疗 (与安慰剂) 与精神分裂症或精神分裂情绪障碍患者的结果之间的关联.
- 具体来说,要调查最近接受治疗的人和最近没有接受治疗的人 (≥4周前) 之间的治疗效果是否不同.
主要方法:
- 单个参与者数据的分析,安慰剂控制,急性期随机临床试验.
- 包括患有精神分裂症或精神分裂情绪障碍的18岁以上的参与者.
- 在6周使用阳性和阴性综合征量表 (PANSS) 分析整体症状,比较最近接受治疗和最近未接受治疗的组.
主要成果:
- 纳入了12项试验,共有2781名参与者 (692人没有最近接受治疗,2089人最近接受治疗).
- 两组之间没有发现抗精神病药与安慰剂治疗对整体症状的影响有显著差异 (DMD:0.8 PANSS点;95% CI:-3.6至5.2).
- 与最近接受治疗的个人相比,未接受最近治疗的个人在抗精神病药物和安慰剂治疗时表现更好.
结论:
- 与安慰剂相比,急性阶段抗精神病治疗的疗效似乎相似,无论精神分裂症谱系障碍的最近治疗状况如何.
- 最近没有接受治疗的个体表现出积极治疗和安慰剂的优异结果,这表明其他因素影响了反应.
- 研究结果表明,治疗史可能不是急性阶段抗精神病反应大小的主要决定因素.
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