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首页> 外文期刊>Primary care companion to the journal of clinical psychiatry >Clinical Outcome After Antipsychotic Treatment Discontinuation in Functionally Recovered First-Episode Nonaffective Psychosis Individuals: A 3-Year Naturalistic Follow-Up Study
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Clinical Outcome After Antipsychotic Treatment Discontinuation in Functionally Recovered First-Episode Nonaffective Psychosis Individuals: A 3-Year Naturalistic Follow-Up Study

机译：功能恢复的第一期非情感性精神病患者抗精神病药物治疗中止后的临床结果：一项为期3年的自然随访研究

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Objective: The timing of antipsychotic discontinuation in patients who have fully recovered from their initial episode of psychosis is still open to discussion. We aimed to evaluate the risk of symptom recurrence during the 3 years after antipsychotic discontinuation in a sample of functionally recovered first-episode nonaffective psychosis (FEP) patients (DSM-IV criteria) with schizophrenia spectrum disorder. Method: Participants in this open-label, nonrandomized, prospective study were drawn from an ongoing longitudinal intervention program of FEP from a university hospital setting in Spain. From July 2004 to February 2011, functionally recovered FEP individuals were eligible if they met the inclusion criteria of (1) a minimum of 18 months on antipsychotic treatment, (2) clinical remission for at least 12 months, (3) functional recovery for at least 6 months, and (4) stabilization at the lowest effective doses for at least 3 months. Forty-six individuals who were willing to discontinue medication were included in the discontinuation group (target group). Twenty-two individuals opted to stay on the prescribed antipsychotic medication and therefore were included in the maintenance group (control group). Primary outcome measures were relapse rate at 18 and 36 months and time to relapse. Results: The rates of relapse over the 3-year period were 67.4% (31 of 46) in the discontinuation group and 31.8% (7 of 22) in the maintenance group. The mean time to relapse was 209 (median = 122) days and 608 (median = 607) days, respectively (log rank = 10.106, P = .001). The resumption of antipsychotic medication after the relapse occurred was associated with clinical stability and lack of further relapses. When the overall group of relapsed individuals from the 2 conditions (N = 38) was compared to those who remained asymptomatic after 3 years (N = 30), there were significant differences (P .05) in total scores on the Scale for the Assessment of Negative Symptoms, the Clinical Global Impressions scale, and the Disability Assessment Schedule. Conclusions: Antipsychotic treatment discontinuation in individuals who had accomplished a functional recovery after a single psychotic episode was associated with a high risk of symptom recurrence. Relapsed individuals had a greater severity of symptoms and lower functional status after 3 years. Trial Registration: ClinicalTrials.gov identifier: NCT02220504
机译：目的：从精神病发作初期完全康复的患者中抗精神病药物停药的时间仍需讨论。我们旨在评估功能恢复的精神分裂症谱系障碍的功能恢复的首发非情感性精神病（FEP）患者（DSM-IV标准）样本中抗精神病药物停药后3年内症状复发的风险。方法：这项开放标签，非随机，前瞻性研究的参与者来自西班牙某大学医院正在进行的FEP纵向干预计划。从2004年7月至2011年2月，功能恢复的FEP个体符合以下条件：（1）至少接受18个月的抗精神病药物治疗;（2）临床缓解至少12个月;（3）达到至少6个月，以及（4）以最低有效剂量稳定至少3个月。愿意停药的46名患者被包括在停药组（目标组）中。有22个人选择继续服用抗精神病药物，因此被包括在维持治疗组（对照组）中。主要结局指标为18个月和36个月的复发率以及复发时间。结果：3年期复发率在停药组中为67.4％（46中的31），在维持组中为31.8％（22中的7）。平均复发时间分别为209天（中位数= 122）天和608天（中位数= 607天）（对数等级= 10.106，P = 0.001）。复发后抗精神病药的恢复与临床稳定性和缺乏进一步复发有关。当将两种情况下的总体复发人群（N = 38）与3年后仍无症状的人群（N = 30）进行比较时，该量表的总分存在显着差异（P <.05）。负面症状的评估，临床总体印象量表和残疾评估时间表。结论：在单次精神病发作后功能恢复的个体中，抗精神病药物治疗的中止与症状复发的高风险相关。 3年后，复发个体的症状严重程度更高，功能状态更低。试验注册：ClinicalTrials.gov标识符：NCT02220504

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