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首页> 外文期刊>The journal of clinical psychiatry >Predictors of Treatment Discontinuation and Medication Nonadherence in Patients Recovering From a First Episode of Schizophrenia, Schizophreniform Disorder, or Schizoaffective Disorder: A Randomized, Double-Blind, Flexible-Dose, Multicenter Study.
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Predictors of Treatment Discontinuation and Medication Nonadherence in Patients Recovering From a First Episode of Schizophrenia, Schizophreniform Disorder, or Schizoaffective Disorder: A Randomized, Double-Blind, Flexible-Dose, Multicenter Study.

机译：从精神分裂症，精神分裂症样疾病或精神分裂性情感障碍首发发作中恢复的患者中止治疗和药物不依从性的预测因素：一项随机，双盲，灵活剂量，多中心研究。

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OBJECTIVE: To evaluate predictors of treatment discontinuation against medical advice and poor medication adherence among first-episode patients treated with olanzapine, quetiapine, or risperidone. METHOD: First-episode patients with schizophrenia, schizophreniform disorder, or schizoaffective disorder (DSM-IV) were randomly assigned to olanzapine (2.5-20 mg/day), quetiapine (100-800 mg/day), or risperidone (0.5-4 mg/day) as part of a 52-week, randomized, double-blind, flexible-dose, multicenter study. Patients were enrolled from 2002 to 2004 at one of 26 sites in the United States and Canada. Survival analysis tested for predictors of treatment discontinuation against medical advice, while mixed models tested for predictors of poor medication adherence. Significant findings from the final models were replicated in sensitivity analyses. RESULTS: Of the 400 patients randomly assigned to treatment, 115 patients who discontinued treatment against medical advice and 119 study completers were compared in this analysis. Poor treatment response (p < .001) and low medication adherence (p = .02) were independent predictors of discontinuation against medical advice. Ongoing substance abuse, ongoing depression, and treatment response failure significantly predicted poor medication adherence (p < .01). Higher cognitive performance at baseline and ethnicity (black) were also associated with lower medication adherence (p < .05). An association between poor medication adherence and illness insight at study entry was found at trend level (p = .059). CONCLUSION: This study highlights the importance of treatment response in predicting discontinuation against medical advice and poor adherence to medication in first-episode patients. These results also support interventions to improve adherence behavior, particularly by targeting substance use disorders and depressive symptoms. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT00034892 (http://www.clinicaltrials.gov).
机译：目的：评估在奥氮平，喹硫平或利培酮治疗的首发患者中，根据医学意见和药物依从性差而终止治疗的预测因素。方法：将精神分裂症，精神分裂症或精神分裂症（DSM-IV）的首发患者随机分为奥氮平（2.5-20 mg /天），喹硫平（100-800 mg /天）或利培酮（0.5-4）毫克/天）作为一项为期52周的随机，双盲，灵活剂量，多中心研究的一部分。从2002年至2004年，患者在美国和加拿大的26个站点之一入组。生存分析根据医学建议测试了治疗终止的预测因素，而混合模型测试了药物依从性差的预测因素。最终模型的重要发现在敏感性分析中得以重复。结果：在该分析的400名随机分配的患者中，对115名根据医学建议终止治疗的患者和119名研究完成者进行了比较。治疗反应差（p <.001）和药物依从性低（p = .02）是中止服药的独立预测因素。持续的药物滥用，持续的抑郁症和治疗反应失败显着预测了药物依从性差（p <.01）。基线和种族（黑人）的较高认知能力也与较低的药物依从性相关（p <.05）。在研究入组时，不良药物依从性与疾病见解之间的关联在趋势水平上被发现（p = .059）。结论：本研究强调了治疗反应在预测首发患者中终止接受医学意见和药物依从性差方面的重要性。这些结果还支持改善依从行为的干预措施，特别是针对药物滥用和抑郁症状。试验注册：ClinicalTrials.gov标识符NCT00034892（http://www.clinicaltrials.gov）。

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