早期剂量减少或停止与第一次精神发作缓解后的维持抗精神病药物:一项随机临床试验
Iris E Sommer1, Franciska de Beer1, Shiral Gangadin1
1Center for Clinical Neuroscience and Cognition, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
JAMA psychiatry
|October 1, 2025
概括
剂量减少或停止 (DRD) 早期的第一发精神病 (FEP) 增加短期的复发风险,但可能会改善长期的功能. 仔细考虑这些风险与潜在的赋权至关重要.
科学领域:
- 精神病学和心理健康 精神病学和心理健康
- 临床试验 临床试验
- 药理学 药理学是指药理学的学科.
背景情况:
- 从第一次精神病发作 (FEP) 早期缓解是治疗决策的关键时刻.
- 缓解后减少剂量或停止 (DRD) 与短期复发风险增加有关.
- 在FEP中DRD后的长期功能结果仍然存在争议,因为研究结果相互矛盾.
研究的目的:
- 为了比较DRD的短期和长期影响与FEP患者在4年的维持抗精神病药物治疗.
- 评估DRD对功能,复发率,症状严重程度和生活质量的影响.
主要方法:
- 针对性治疗的处理抗精神病药物长期评估 (HAMLETT) 研究是一项务实的,单盲,随机的临床试验.
- 347名FEP缓解患者被随机 (1:1) 分给缓解后12个月内或维持治疗12个月内早期的DRD.
- 结果包括患者评估功能 (WHODAS-2),研究人员评估功能 (GAF),生活质量,复发和症状严重程度 (PANSS).
主要成果:
- 在第一年,DRD与更高的复发风险 (OR=2.84) 和更低的生活质量有关.
- 从第三年开始,DRD显示出研究人员评价的全球功能 (GAF) 显著改善,并趋向于改善症状严重程度 (PANSS).
- 严重的不良事件是相似的,但在DRD组中发生了3起自杀事件,而在维护组中发生了1起.
结论:
- 在FEP中,DRD带有短期复发和降低生活质量的风险.
- 然而,DRD可能会导致长期改善功能和症状控制,可能是由于增强了应对能力.
- 对DRD的决定需要仔细平衡短期风险与潜在的长期益处以及患者赋权.
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