首发非情感性精神病和大麻使用障碍患者的抗精神病药物使用和精神病住院情况:瑞典全国队列研究》。

IF 5.3 1区 医学 Q1 PSYCHIATRY
Alexander Denissoff, Heidi Taipale, Jari Tiihonen, Marta Di Forti, Ellenor Mittendorfer-Rutz, Antti Tanskanen, Antti Mustonen, Solja Niemelä
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引用次数: 0

摘要

背景和假设:有关精神病和大麻使用障碍(CUD)患者治疗效果的研究很少。我们旨在比较抗精神病药物在降低首发精神病(FEP)和并发 CUD 患者住院风险方面的有效性:我们利用了瑞典全国范围内的患者队列,其中包含 2006 年至 2021 年的纵向登记数据。研究对象为患有 FEP 并合并 CUD 的患者(n = 1820,84.73% 为男性,平均年龄 26.80 岁,SD 为 8.25 岁)。主要结果是因精神病复发而住院。任何精神障碍或药物使用障碍(SUD)导致的住院治疗均为次要结果。研究采用了个体内 Cox 回归模型来研究这些关联:研究结果:使用任何一种抗精神病药物均可降低 33% 的精神病复发风险(aHR = 0.67;95% CI 0.60-0.75)。氯氮平(0.43;0.29-0.64)、利培酮长效注射剂(0.40;0.22-0.71)、阿立哌唑(0.42;0.27-0.65)和帕利哌酮(0.46;0.30-0.69)的复发风险最低。奥氮平的LAI制剂与因精神病住院之间的关系在统计学上并不显著(0.61;0.35-1.05)。氯氮平可将因 SUD 而住院的风险降低 86%(0.14;0.05-0.44)。在口服非氯氮平类抗精神病药物中,阿立哌唑与精神病复发导致的住院风险最低相关(0.61;0.45-0.83):这些研究结果支持使用氯氮平、除奥氮平以外的第二代抗精神病药物的LAI制剂或口服阿立哌唑来预防FEP和合并CUD患者的住院治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Antipsychotic Use and Psychiatric Hospitalization in First-Episode Non-affective Psychosis and Cannabis Use Disorder: A Swedish Nationwide Cohort Study.

Background and hypothesis: There is a paucity of research on treatment outcomes of patients with psychosis and cannabis use disorder (CUD). We aimed to compare the effectiveness of antipsychotics in reducing the risk of hospitalization in patients with first-episode psychosis (FEP) and co-occurring CUD.

Study design: We utilized a nationwide Swedish cohort of patients with longitudinal register data from the year 2006 to 2021. Participants were patients with FEP and co-occurring CUD (n = 1820, 84.73% men, mean age 26.80 years, SD 8.25 years). The main outcome was hospitalization due to psychotic relapse. Hospitalization due to any psychiatric disorder or substance use disorder (SUD) were examined as secondary outcomes. Within-individual Cox regression models were used to study these associations.

Study results: Use of any antipsychotic was associated with a 33% risk reduction of psychotic relapse (aHR = 0.67; 95% CI 0.60-0.75). Clozapine (0.43; 0.29-0.64), long-acting injectable (LAI) formulations of risperidone (0.40; 0.22-0.71), aripiprazole (0.42; 0.27-0.65), and paliperidone (0.46; 0.30-0.69) were associated with the lowest risk of relapse. The association between the LAI formulation of olanzapine and hospitalization due to psychosis was statistically non-significant (0.61; 0.35-1.05). Clozapine was associated with an 86% risk reduction of hospitalization due to SUD (0.14; 0.05-0.44). Of oral non-clozapine antipsychotics, aripiprazole was associated with the lowest risk of hospitalization due to psychotic relapse (0.61; 0.45-0.83).

Conclusions: These findings support the use of clozapine, LAI formulations of second-generation antipsychotics other than olanzapine, or oral aripiprazole to prevent hospitalization in FEP and co-occurring CUD.

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来源期刊
Schizophrenia Bulletin
Schizophrenia Bulletin 医学-精神病学
CiteScore
11.40
自引率
6.10%
发文量
163
审稿时长
4-8 weeks
期刊介绍: Schizophrenia Bulletin seeks to review recent developments and empirically based hypotheses regarding the etiology and treatment of schizophrenia. We view the field as broad and deep, and will publish new knowledge ranging from the molecular basis to social and cultural factors. We will give new emphasis to translational reports which simultaneously highlight basic neurobiological mechanisms and clinical manifestations. Some of the Bulletin content is invited as special features or manuscripts organized as a theme by special guest editors. Most pages of the Bulletin are devoted to unsolicited manuscripts of high quality that report original data or where we can provide a special venue for a major study or workshop report. Supplement issues are sometimes provided for manuscripts reporting from a recent conference.
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