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Role of long-acting injectable second-generation antipsychotics in the treatment of first-episode schizophrenia: a clinical perspective. 长效注射第二代抗精神病药物在治疗首发精神分裂症中的作用:临床观察。
IF 2.4 Q1 PSYCHIATRY Pub Date : 2012-01-01 Epub Date: 2012-05-07 DOI: 10.1155/2012/764769
Radovan Přikryl, Hana Přikrylová Kučerová, Michaela Vrzalová, Eva Cešková

Approximately 80% of patients with the first-episode schizophrenia reach symptomatic remission after antipsychotic therapy. However, within two years most of them relapse, mainly due to low levels of insight into the illness and nonadherence to their oral medication. Therefore, although the formal data available is limited, many experts recommend prescribing long-acting injectable second-generation antipsychotics (mostly risperidone or alternatively paliperidone) in the early stages of schizophrenia, particularly in patients who have benefited from the original oral molecule in the past and agree to receive long-term injectable treatment. Early application of long-acting injectable second-generation antipsychotics can significantly reduce the risk of relapse in the future and thus improve not only the social and working potential of patients with schizophrenia but also their quality of life.

大约80%的首发精神分裂症患者在抗精神病药物治疗后症状缓解。然而,在两年内,他们中的大多数人复发,主要是由于对疾病的了解程度低和不坚持口服药物。因此,尽管可获得的正式数据有限,但许多专家建议在精神分裂症的早期阶段开具长效注射第二代抗精神病药物(主要是利培酮或替代帕利培酮),特别是那些过去曾受益于原始口服分子并同意接受长期注射治疗的患者。早期应用长效注射型第二代抗精神病药物可显著降低未来复发的风险,从而提高精神分裂症患者的社会和工作潜力,提高其生活质量。
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引用次数: 31
Hospitalisation Utilisation and Costs in Schizophrenia Patients in Finland before and after Initiation of Risperidone Long-Acting Injection. 芬兰精神分裂症患者开始长效注射利培酮前后的住院利用和费用
IF 2.4 Q1 PSYCHIATRY Pub Date : 2012-01-01 Epub Date: 2012-05-07 DOI: 10.1155/2012/791468
Christian Asseburg, Michael Willis, Mickael Löthgren, Niko Seppälä, Mika Hakala, Ulf Persson

Objectives. Quantify changes in hospital resource use in Finland following initiation of risperidone long-acting injection (RLAI). Materials and Methods. A retrospective multi-center chart review (naturalistic setting) was used to compare annual hospital bed-days and hospital episodes for 177 schizophrenia patients (mean age 47.1 years, 52% female, 72% hospitalized) before and after initiation of RLAI (between January 2004 and June 2005) using the within-patient "mirror-image" study design. The base case analytical approach allocated hospital episodes overlapping the start date entirely to the preinitiation period. In order to investigate the impact of inpatient care ongoing at baseline, the change in bed-days was also estimated using an alternative analytical approached related to economic modelling. Results. In the conventional analysis, the mean annual hospitalisation costs declined by €11,900 and the number of bed-days was reduced by 40%, corresponding to 0.19 fewer hospital episodes per year. The reductions in bed-days per patient-year were similar for patients switched to RLAI as inpatients and as outpatients. In the modelling-based analysis, an 8% reduction in bed-days per year was observed. Conclusion. Despite uncertainty in the choice of analytic approach for allocating inpatient episodes that overlapping this initiation, consistent reductions in resource use are associated with the initiation of RLAI in Finland.

目标。量化芬兰开始使用利培酮长效注射(RLAI)后医院资源使用的变化。材料与方法。采用回顾性多中心图表回顾(自然设置)比较177例精神分裂症患者(平均年龄47.1岁,52%为女性,72%住院)在RLAI开始前后(2004年1月至2005年6月)的年度住院天数和住院事件。基本病例分析方法将开始日期重叠的医院发作完全分配到起始期前。为了调查住院治疗对基线的影响,还使用与经济模型相关的另一种分析方法估计了住院天数的变化。结果。在传统分析中,平均每年住院费用下降了11,900欧元,住院天数减少了40%,相当于每年减少0.19次住院发作。对于转到RLAI的住院和门诊患者,每个患者年的住院天数减少是相似的。在基于模型的分析中,观察到每年卧床天数减少8%。结论。尽管在分配重叠的住院发作的分析方法的选择上存在不确定性,但在芬兰,资源使用的持续减少与RLAI的启动有关。
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引用次数: 16
Neurocognitive and social cognitive approaches for improving functional outcome in early psychosis: theoretical considerations and current state of evidence. 改善早期精神病功能性结果的神经认知和社会认知方法:理论考虑和证据现状。
IF 2.4 Q1 PSYCHIATRY Pub Date : 2012-01-01 Epub Date: 2012-04-05 DOI: 10.1155/2012/815315
Cali F Bartholomeusz, Kelly Allott

Improving functional outcome, in addition to alleviating psychotic symptoms, is now a major treatment objective in schizophrenia research. Given the large body of evidence suggesting pharmacological treatments generally have minimal effects on indices of functioning, research has turned to psychosocial rehabilitation programs. Among these, neurocognitive and social cognitive interventions are at the forefront of this field and are argued to target core deficits inherent to the schizophrenia illness. However, to date, research trials have primarily focused on chronic schizophrenia populations, neglecting the early psychosis groups who are often as severely impaired in social and occupational functioning. This theoretical paper will outline the rationale for investigating adjunctive cognitive-based interventions in the early phases of psychotic illness, critically examine the current approach strategies used in these interventions, and assess the evidence supporting certain training programs for improving functional outcome in early psychosis. Potential pathways for future research will be discussed.

除了缓解精神症状之外,改善功能结果也是目前精神分裂症研究的一个主要治疗目标。有大量证据表明,药物治疗通常对功能指数的影响微乎其微,因此研究转向了社会心理康复计划。其中,神经认知和社会认知干预是这一领域的前沿,被认为是针对精神分裂症疾病固有的核心缺陷。然而,迄今为止,研究试验主要集中于慢性精神分裂症患者,而忽视了早期精神病患者,因为他们的社会和职业功能往往受到严重损害。这篇理论性论文将概述研究精神病早期阶段基于认知的辅助干预措施的基本原理,批判性地审视目前这些干预措施所采用的方法策略,并评估支持某些训练计划改善早期精神病功能结果的证据。本文还将讨论未来研究的潜在途径。
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引用次数: 0
Long-acting injectable antipsychotics for first-episode schizophrenia: the pros and cons. 长效注射抗精神病药物治疗首发精神分裂症:利弊。
IF 2.4 Q1 PSYCHIATRY Pub Date : 2012-01-01 Epub Date: 2012-08-14 DOI: 10.1155/2012/560836
Borah Kim, Sang-Hyuk Lee, Yen Kuang Yang, Jong-Il Park, Young-Chul Chung

Clinical and psychosocial deterioration associated with schizophrenia occurs within the first few years following the onset of the illness. Therefore, to improve the long-term prognosis, it is important to provide schizophrenia patients with intensive treatment following their first episode. Relapse is highly associated with partial medication adherence or nonadherence in patients with first-episode schizophrenia. Recent studies suggest that long-acting injectable (LAI) antipsychotics compared with oral antipsychotics are more effective for medication adherence and relapse prevention. Moreover, some clinical guidelines for the treatment of schizophrenia suggested that LAI antipsychotics should be considered when patients are nonadherent "at any stage." Decreased compliance is a common cause of relapse during the initial stages of the disease. Therefore, LAI antipsychotics should be highly considered when treating patients with first-episode schizophrenia. In the present paper, clinical trial data and current guidelines on the use of LAI antipsychotics for first-episode schizophrenia are discussed as well as the pros and cons of this treatment option.

与精神分裂症相关的临床和社会心理恶化发生在发病后的最初几年内。因此,为了改善长期预后,在精神分裂症患者首次发作后给予强化治疗是很重要的。复发与首发精神分裂症患者的部分药物依从性或不依从性高度相关。最近的研究表明,长效注射抗精神病药物与口服抗精神病药物相比,在药物依从性和预防复发方面更有效。此外,一些精神分裂症治疗的临床指南建议,当患者“在任何阶段”都没有依从性时,应考虑使用LAI抗精神病药物。降低依从性是疾病初期复发的常见原因。因此,在治疗首发精神分裂症患者时,应高度考虑使用LAI抗精神病药物。本文对首发精神分裂症使用LAI抗精神病药物的临床试验数据和现行指南进行了讨论,并对这种治疗方案的利弊进行了讨论。
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引用次数: 53
Long-acting injectable antipsychotics in first-episode schizophrenia. 长效注射抗精神病药物在首发精神分裂症中的应用。
IF 2.4 Q1 PSYCHIATRY Pub Date : 2012-01-01 Epub Date: 2012-08-21 DOI: 10.1155/2012/318535
Eduard Parellada, Dawn I Velligan, Robin Emsley, Werner Kissling
Long-acting injectable antipsychotics (LAIAs) may improve adherence to treatment and reduce the rate of relapse and rehospitalization in first-episode or recent-onset schizophrenia (e.g., less than 2 years of illness duration). However, despite their potential advantages, LAIAs are underutilised in clinical practice and the place of LAIAs in the early phases of schizophrenia is still a controversial clinical issue. For example, negative attitudes toward LAIAs in first-episode schizophrenia among psychiatrists are common, and the place of LAIAs for first-episode psychoses (FEPs) remains uncertain in the current clinical guidelines for the pharmacological treatment of schizophrenia. Moreover, a recent paper published in the New England Journal of Medicine by Rosenheck et al. [1] reported negative results of LAI risperidone (RLAI) on relapse prevention, although this was in a multiepisode sample. The recent and forthcoming availability of additional second-generation LAIAs (SG-LAIAs), namely, olanzapine pamoate, paliperidone palmitate, aripiprazole, and iloperidone depot, will add interest to this clinical debate for practicing clinicians and researchers interested in this timely topic.
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引用次数: 13
Treatment adherence with early prescription of long-acting injectable antipsychotics in recent-onset schizophrenia. 早期注射长效抗精神病药物治疗新发精神分裂症的依从性。
IF 2.4 Q1 PSYCHIATRY Pub Date : 2012-01-01 Epub Date: 2012-04-03 DOI: 10.1155/2012/368687
Annie Viala, Françoise Cornic, Marie-Noëlle Vacheron

Although response to treatment for the first episode of schizophrenia is generally favourable, nonadherence with the treatment is the first cause of relapse and rehospitalisation within the next few years. Long-acting injectable antipsychotics (LAIAs) combine the advantages of the newer antipsychotics and the long-acting formulation. The evaluation concerns 25 schizophrenic patients hospitalised for the first time, treated with risperidone long-acting injectable (RLAI) associated with reintegration methods, and followed up for at least 18 months. Clinical observation was completed using Clinical Global Impression (CGI) scale and Global Assessment of Functioning (GAF). Clinical improvement was coupled with a good reintegration rate, very few relapse, or rehospitalisation. Bimonthly injection combined with psychosocial methods improved interactive followup, and therefore patients' compliance with the treatment. Treating with LAIA as early as possible, from the first episode if possible, can reduce relapse, number and duration of rehospitalisation, and cognitive symptoms and improve the quality of life and prognosis.

虽然对精神分裂症首次发作的治疗反应通常是有利的,但不坚持治疗是在未来几年内复发和再住院的首要原因。长效注射抗精神病药物(LAIAs)结合了新型抗精神病药物和长效制剂的优点。该评估涉及25名首次住院的精神分裂症患者,接受利培酮长效注射(RLAI)治疗并结合重返社会方法,并随访至少18个月。采用临床整体印象量表(CGI)和整体功能评估量表(GAF)完成临床观察。临床改善伴随着良好的重返社会率,极少复发或再住院。每两个月一次的注射结合社会心理方法改善了互动随访,从而提高了患者对治疗的依从性。尽早(如果可能的话,从第一次发作开始)使用LAIA治疗,可以减少复发、再住院次数和持续时间以及认知症状,并改善生活质量和预后。
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引用次数: 23
Schizophrenia as a disorder of social communication. 精神分裂症是一种社会沟通障碍。
IF 2.4 Q1 PSYCHIATRY Pub Date : 2012-01-01 Epub Date: 2012-05-20 DOI: 10.1155/2012/920485
Cynthia Gayle Wible

Evidence is reviewed for the existence of a core system for moment-to-moment social communication that is based on the perception of dynamic gestures and other social perceptual processes in the temporal-parietal occipital junction (TPJ), including the posterior superior temporal sulcus (PSTS) and surrounding regions. Overactivation of these regions may produce the schizophrenic syndrome. The TPJ plays a key role in the perception and production of dynamic social, emotional, and attentional gestures for the self and others. These include dynamic gestures of the body, face, and eyes as well as audiovisual speech and prosody. Many negative symptoms are characterized by deficits in responding within these domains. Several properties of this system have been discovered through single neuron recording, brain stimulation, neuroimaging, and the study of neurological impairment. These properties map onto the schizophrenic syndrome. The representation of dynamic gestures is multimodal (auditory, visual, and tactile), matching the predominant hallucinatory categories in schizophrenia. Inherent in the perceptual signal of gesture representation is a computation of intention, agency, and anticipation or expectancy (for the self and others). The neurons are also tuned or biased to rapidly detect threat-related emotions. I review preliminary evidence that overactivation of this system can result in schizophrenia.

本文回顾了在颞顶枕交界处(TPJ),包括颞后上沟(PSTS)及其周围区域,存在一个基于动态手势感知和其他社会感知过程的即时到即时社会交流核心系统的证据。这些区域的过度激活可能产生精神分裂症综合征。TPJ在感知和产生动态的社会、情感和注意力手势中起着关键作用。这些包括身体、面部和眼睛的动态手势,以及视听语言和韵律。许多阴性症状的特点是在这些领域的反应不足。通过单神经元记录、脑刺激、神经成像和神经损伤研究,已经发现了该系统的一些特性。这些特征反映了精神分裂症综合症。动态手势的表现是多模态的(听觉、视觉和触觉),与精神分裂症中主要的幻觉类别相匹配。手势表征的感知信号中固有的是对意图、代理和预期或期望(对自己和他人)的计算。神经元也被调整或偏向于快速检测与威胁相关的情绪。我回顾了这个系统过度激活会导致精神分裂症的初步证据。
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引用次数: 45
The role of oestrogen and other hormones in the pathophysiology and treatment of schizophrenia. 雌激素和其他激素在精神分裂症病理生理和治疗中的作用。
IF 2.4 Q1 PSYCHIATRY Pub Date : 2012-01-01 Epub Date: 2012-02-19 DOI: 10.1155/2012/540273
Emily Hayes, Emorfia Gavrilidis, Jayashri Kulkarni

The theory that many serious mental illnesses, in particular psychoses such as schizophrenia, may have a significant hormonal aetiological component is fast gaining popularity and the support of scientific evidence. Oestrogen in particular has been substantially investigated as a potential mediator of brain function in schizophrenia. Epidemiological and life-cycle data point to significant differences in the incidence and course of schizophrenia between men and women suggests a protective role of oestrogen. In vitro and in vivo preclinical research confirms oestradiol's interactions with central neurotransmitter systems implicated in the pathogenesis of schizophrenia, while results from randomised controlled trials investigating the antipsychotic potential of oestrogen have been positive. Research into other neuroactive hormones with possible effects on mental state is a rapidly evolving field that may hold new promise. Given that schizophrenia and related psychoses are pervasive and debilitating conditions for which currently available treatments are often only partially effective and entail a high risk of serious side-effects, novel therapeutic strategies are needed. The literature reviewed in this paper suggests that hormones such as oestrogen could be a viable option, and it is hoped that with further research and larger trials, the oestrogen hypothesis can be translated into effective clinical practice.

许多严重的精神疾病,特别是精神分裂症等精神病,可能有重要的激素致病因素,这一理论正迅速流行起来,并得到科学证据的支持。特别是雌激素作为精神分裂症脑功能的潜在中介已经被大量研究。流行病学和生命周期数据表明,男性和女性精神分裂症的发病率和病程存在显著差异,这表明雌激素具有保护作用。体外和体内临床前研究证实,雌二醇与中枢神经递质系统的相互作用与精神分裂症的发病机制有关,而调查雌激素抗精神病潜力的随机对照试验的结果是积极的。对其他可能影响精神状态的神经活性激素的研究是一个快速发展的领域,可能会带来新的希望。鉴于精神分裂症和相关精神病是普遍存在的、使人衰弱的疾病,目前可用的治疗方法往往只是部分有效,而且会带来严重副作用的高风险,因此需要新的治疗策略。本文综述的文献表明,雌激素等激素可能是一种可行的选择,希望通过进一步的研究和更大规模的试验,雌激素假说可以转化为有效的临床实践。
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引用次数: 37
Oral versus Long-Acting Injectable Antipsychotics in the Treatment of Schizophrenia and Special Populations at Risk for Treatment Nonadherence: A Systematic Review. 口服与长效注射抗精神病药物治疗精神分裂症和治疗不依从风险的特殊人群:一项系统综述。
IF 2.4 Q1 PSYCHIATRY Pub Date : 2012-01-01 Epub Date: 2012-02-15 DOI: 10.1155/2012/407171
Simon Zhornitsky, Emmanuel Stip

Long-acting injectable antipsychotics (LAIs) should offer better efficacy and tolerability, compared to oral antipsychotics due to improved adherence and more stable pharmacokinetics. However, data on LAIs has been mixed, with some studies finding that they are more effective and tolerable than oral antipsychotics, and others finding the contrary. One possibility for the disparate results may be that some studies administered different antipsychotics in the oral and injectable form. The present systematic review examined the efficacy and tolerability of LAIs versus their oral equivalents in randomized and naturalistic studies. In addition, it examined the impact of LAIs on special populations such as patients with first-episode psychosis, substance use disorders, and a history of violence or on involuntary outpatient commitment. Randomized studies suggest that not all LAIs are the same; for example, long-acting risperidone may be associated with equal or less side effects than oral risperidone, whereas fluphenazine decanoate and enanthate may be associated with equal or more side effects than oral fluphenazine. They also suggest that LAIs reduce risk of relapse versus oral antipsychotics in schizophrenia outpatients when combined with quality psychosocial interventions. For their part, naturalistic studies point to a larger magnitude of benefit for LAIs, relative to their oral equivalents particularly among first-episode patients.

与口服抗精神病药物相比,长效注射抗精神病药物(LAIs)由于更好的依从性和更稳定的药代动力学,应该具有更好的疗效和耐受性。然而,关于人工智能药物的数据好坏参半,一些研究发现它们比口服抗精神病药物更有效、更耐受性,而另一些研究则发现相反。不同结果的一种可能是,一些研究在口服和注射形式中使用了不同的抗精神病药物。本系统综述在随机和自然研究中比较了LAIs与口服等效物的疗效和耐受性。此外,它还检查了LAIs对特殊人群的影响,如首发精神病患者、物质使用障碍患者、有暴力史患者或非自愿门诊患者。随机研究表明,并非所有lai都是相同的;例如,长效利培酮的副作用可能与口服利培酮相同或更少,而癸酸氟那嗪和烯酸氟那嗪的副作用可能与口服氟那嗪相同或更多。他们还建议,与口服抗精神病药物相比,精神分裂症门诊患者在结合高质量的社会心理干预时,LAIs可降低复发风险。对于他们来说,自然主义的研究指出,相对于口服药物,LAIs的益处更大,尤其是在首发患者中。
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引用次数: 101
Where Does Evidence from New Trials for Schizophrenia Fit with the Existing Evidence: A Case of the Emperor's New Clothes? 精神分裂症新试验的证据与现有证据在哪里相符:皇帝新衣的案例?
IF 2.4 Q1 PSYCHIATRY Pub Date : 2012-01-01 Epub Date: 2012-04-08 DOI: 10.1155/2012/625738
Mahesh Jayaram, Ranganath D Rattehalli, Clive E Adams

Advent of "atypical" antipsychotics has spawned new trials in the recent years and the number of such trial reports has been increasing exponentially. As clinicians we have been led to believe that "atypicals" are better than "typicals" despite the odd dissenting voice in academic and clinical circles. This has been largely ignored until the publication of two landmark, independent, pragmatic trials, Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) and Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS), which proved that thoughtfully chosen "typical" antipsychotics were as good as the newer "atypicals." We pooled "leaving the study early data" from Cochrane Reviews that existed before CATIE and CUtLASS and added data from CATIE and CUtLASS to the pool for a "before and after" comparison. Addition of CATIE and CUtLASS data only led to narrowing of the already existing confidence intervals, merely increasing precision, and decreasing the risk of Type II error. Perhaps surprisingly, CATIE and CUtLASS when pooled with the already existing data showed us that we had chosen to turn a blind eye to findings that already existed. This leads clinicians to question as to whether, in future, we need to feel less guilty about crying out early on that the emperor has no clothes on.

近年来,“非典型”抗精神病药物的出现催生了新的试验,此类试验报告的数量呈指数级增长。作为临床医生,我们一直被引导相信“非典型”比“典型”好,尽管在学术和临床圈子里有奇怪的反对声音。这在很大程度上被忽视了,直到两项具有里程碑意义的、独立的、实用的试验——精神分裂症研究中最新抗精神病药物的干预有效性临床抗精神病药物试验(CATIE)和成本效用(CUtLASS)的发表,证明了精心选择的“典型”抗精神病药物与较新的“非典型”抗精神病药物一样好。我们汇集了在CATIE和CUtLASS之前存在的Cochrane综述中的“早期离开研究数据”,并将CATIE和CUtLASS的数据加入到“前后”比较池中。CATIE和CUtLASS数据的增加只导致已经存在的置信区间的缩小,仅仅增加了精度,并降低了II型错误的风险。也许令人惊讶的是,当CATIE和CUtLASS与已经存在的数据结合在一起时,我们发现我们选择了对已经存在的发现视而不见。这让临床医生提出了一个问题:在未来,我们是否需要对过早地大喊“皇帝没穿衣服”感到不那么内疚?
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引用次数: 2
期刊
Schizophrenia Research and Treatment
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