{"title":"精神分裂症患者中氯氮平可用性、难治性精神分裂症亚组诊断、抗精神病单药治疗和伴随精神药物之间的关系：一项真实世界的全国性研究","authors":"Shinichiro Ochi, Fumitoshi Kodaka, Naomi Hasegawa, Takashi Tsuboi, Kazutaka Ohi, Shun Igarashi, Kentaro Fukumoto, Jun-Ichi Iga, Hiroyuki Muraoka, Hitoshi Iida, Hiromi Tagata, Hiroko Kashiwagi, Shusuke Numata, Hirotaka Yamagata, Masahiro Takeshima, Kayo Ichihashi, Naoki Hashimoto, Tatsuya Nagasawa, Toshinori Nakamura, Junya Matsumoto, Hisashi Yamada, Hikaru Hori, Shu-Ichi Ueno, Ken Inada, Ryota Hashimoto, Norio Yasui-Furukori","doi":"10.1093/ijnp/pyaf011","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and hypothesis: </strong>The rate of antipsychotic polypharmacy is high. One risk factor for antipsychotic polypharmacy may be the severity of schizophrenia, including treatment-resistant schizophrenia (TRS). We hypothesized that the institutions that are able to prescribe clozapine present differences in pharmacological treatment even before TRS is diagnosed.</p><p><strong>Study design: </strong>A total of 8155 patients with schizophrenia were divided into the clozapine-available institution (CAI) group and the clozapine-unavailable institution (CUI) group. The psychotropic prescription rates at discharge were compared between the two groups. Furthermore, to investigate whether the diagnosis of TRS subgroups influenced treatment efficacy, we compared CAIs and CUIs with descriptions of subgroups with TRS (DSTRS) and those without descriptions of subgroups with TRS (NDSTRS).</p><p><strong>Results: </strong>Compared to the CUI group, the rates of both antipsychotic monotherapy (58.3% vs. 50.7%; p = 2.4 × 10-7) and antipsychotic monotherapy without the concomitant use of other psychotropics (20.4% vs. 15.6%; p = 3.8 × 10-5) were significantly higher in the CAI group. The rate of antipsychotic monotherapy in the CAI with DSTRS group (63.3%) was significantly higher than that in the CAI with NDSTRS group (54.5%; p = 1.4 × 10-12), the CUI with DSTRS group (49.6%; p = 4.9 × 10-9), and the CUI with NDSTRS group (50.9%; p = 2.0 × 10-8). The rate of antipsychotic monotherapy without the concomitant use of other psychotropics in the CAI with DSTRS group (22.6%) was also significantly higher than that in the CAI with NDSTRS group (18.7%; p = 4.7 × 10-4), the CUI with DSTRS group (15.9%; p = 5.5 × 10-4), and the CUI with NDSTRS group (15.2%; p = 8.0 × 10-5). There was no significant difference in these rates between the other groups.</p><p><strong>Conclusions: </strong>Both the availability of clozapine prescriptions and the precise diagnosis of TRS subgroups at discharge can promote the development of an organizational culture that facilitates the treatment of patients with schizophrenia.</p>","PeriodicalId":14134,"journal":{"name":"International Journal of Neuropsychopharmacology","volume":" ","pages":""},"PeriodicalIF":4.5000,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Associations between clozapine availability, the diagnosis of treatment-resistant schizophrenia subgroups, antipsychotic monotherapy and concomitant psychotropics among patients with schizophrenia: A real-world nationwide study.\",\"authors\":\"Shinichiro Ochi, Fumitoshi Kodaka, Naomi Hasegawa, Takashi Tsuboi, Kazutaka Ohi, Shun Igarashi, Kentaro Fukumoto, Jun-Ichi Iga, Hiroyuki Muraoka, Hitoshi Iida, Hiromi Tagata, Hiroko Kashiwagi, Shusuke Numata, Hirotaka Yamagata, Masahiro Takeshima, Kayo Ichihashi, Naoki Hashimoto, Tatsuya Nagasawa, Toshinori Nakamura, Junya Matsumoto, Hisashi Yamada, Hikaru Hori, Shu-Ichi Ueno, Ken Inada, Ryota Hashimoto, Norio Yasui-Furukori\",\"doi\":\"10.1093/ijnp/pyaf011\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and hypothesis: </strong>The rate of antipsychotic polypharmacy is high. One risk factor for antipsychotic polypharmacy may be the severity of schizophrenia, including treatment-resistant schizophrenia (TRS). We hypothesized that the institutions that are able to prescribe clozapine present differences in pharmacological treatment even before TRS is diagnosed.</p><p><strong>Study design: </strong>A total of 8155 patients with schizophrenia were divided into the clozapine-available institution (CAI) group and the clozapine-unavailable institution (CUI) group. The psychotropic prescription rates at discharge were compared between the two groups. Furthermore, to investigate whether the diagnosis of TRS subgroups influenced treatment efficacy, we compared CAIs and CUIs with descriptions of subgroups with TRS (DSTRS) and those without descriptions of subgroups with TRS (NDSTRS).</p><p><strong>Results: </strong>Compared to the CUI group, the rates of both antipsychotic monotherapy (58.3% vs. 50.7%; p = 2.4 × 10-7) and antipsychotic monotherapy without the concomitant use of other psychotropics (20.4% vs. 15.6%; p = 3.8 × 10-5) were significantly higher in the CAI group. The rate of antipsychotic monotherapy in the CAI with DSTRS group (63.3%) was significantly higher than that in the CAI with NDSTRS group (54.5%; p = 1.4 × 10-12), the CUI with DSTRS group (49.6%; p = 4.9 × 10-9), and the CUI with NDSTRS group (50.9%; p = 2.0 × 10-8). The rate of antipsychotic monotherapy without the concomitant use of other psychotropics in the CAI with DSTRS group (22.6%) was also significantly higher than that in the CAI with NDSTRS group (18.7%; p = 4.7 × 10-4), the CUI with DSTRS group (15.9%; p = 5.5 × 10-4), and the CUI with NDSTRS group (15.2%; p = 8.0 × 10-5). There was no significant difference in these rates between the other groups.</p><p><strong>Conclusions: </strong>Both the availability of clozapine prescriptions and the precise diagnosis of TRS subgroups at discharge can promote the development of an organizational culture that facilitates the treatment of patients with schizophrenia.</p>\",\"PeriodicalId\":14134,\"journal\":{\"name\":\"International Journal of Neuropsychopharmacology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":4.5000,\"publicationDate\":\"2025-03-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Neuropsychopharmacology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/ijnp/pyaf011\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Neuropsychopharmacology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ijnp/pyaf011","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景与假设：抗精神病药物的多重用药率很高。精神分裂症（包括耐药精神分裂症（TRS））的严重程度可能是导致抗精神病药物多药治疗的风险因素之一。我们假设，能够开具氯氮平处方的机构甚至在确诊 TRS 之前就在药物治疗方面存在差异：共有 8155 名精神分裂症患者被分为可使用氯氮平的机构（CAI）组和不可使用氯氮平的机构（CUI）组。比较了两组患者出院时的精神药物处方率。此外，为了研究TRS亚组的诊断是否会影响治疗效果，我们比较了有TRS亚组描述（DSTRS）和无TRS亚组描述（NDSTRS）的CAI组和CUI组：与 CUI 组相比，CAI 组的单一抗精神病药物治疗率（58.3% 对 50.7%；P = 2.4 × 10-7）和未同时使用其他精神药物的单一抗精神病药物治疗率（20.4% 对 15.6%；P = 3.8 × 10-5）均显著高于 CUI 组。使用 DSTRS 的 CAI 组（63.3%）的单一抗精神病药物治疗率明显高于使用 NDSTRS 的 CAI 组（54.5%；p = 1.4 × 10-12）、使用 DSTRS 的 CUI 组（49.6%；p = 4.9 × 10-9）和使用 NDSTRS 的 CUI 组（50.9%；p = 2.0 × 10-8）。使用 DSTRS 的 CAI 组（22.6%）在未同时使用其他精神药物的情况下使用单一抗精神病药物治疗的比例也明显高于使用 NDSTRS 的 CAI 组（18.7%；p = 4.7 × 10-4）、使用 DSTRS 的 CUI 组（15.9%；p = 5.5 × 10-4）和使用 NDSTRS 的 CUI 组（15.2%；p = 8.0 × 10-5）。结论：氯氮平和 NDSTRS 两种药物的可得性和疗效都很好：结论：氯氮平处方的可用性和出院时对 TRS 亚组的精确诊断可促进有利于精神分裂症患者治疗的组织文化的发展。
Associations between clozapine availability, the diagnosis of treatment-resistant schizophrenia subgroups, antipsychotic monotherapy and concomitant psychotropics among patients with schizophrenia: A real-world nationwide study.
Background and hypothesis: The rate of antipsychotic polypharmacy is high. One risk factor for antipsychotic polypharmacy may be the severity of schizophrenia, including treatment-resistant schizophrenia (TRS). We hypothesized that the institutions that are able to prescribe clozapine present differences in pharmacological treatment even before TRS is diagnosed.
Study design: A total of 8155 patients with schizophrenia were divided into the clozapine-available institution (CAI) group and the clozapine-unavailable institution (CUI) group. The psychotropic prescription rates at discharge were compared between the two groups. Furthermore, to investigate whether the diagnosis of TRS subgroups influenced treatment efficacy, we compared CAIs and CUIs with descriptions of subgroups with TRS (DSTRS) and those without descriptions of subgroups with TRS (NDSTRS).
Results: Compared to the CUI group, the rates of both antipsychotic monotherapy (58.3% vs. 50.7%; p = 2.4 × 10-7) and antipsychotic monotherapy without the concomitant use of other psychotropics (20.4% vs. 15.6%; p = 3.8 × 10-5) were significantly higher in the CAI group. The rate of antipsychotic monotherapy in the CAI with DSTRS group (63.3%) was significantly higher than that in the CAI with NDSTRS group (54.5%; p = 1.4 × 10-12), the CUI with DSTRS group (49.6%; p = 4.9 × 10-9), and the CUI with NDSTRS group (50.9%; p = 2.0 × 10-8). The rate of antipsychotic monotherapy without the concomitant use of other psychotropics in the CAI with DSTRS group (22.6%) was also significantly higher than that in the CAI with NDSTRS group (18.7%; p = 4.7 × 10-4), the CUI with DSTRS group (15.9%; p = 5.5 × 10-4), and the CUI with NDSTRS group (15.2%; p = 8.0 × 10-5). There was no significant difference in these rates between the other groups.
Conclusions: Both the availability of clozapine prescriptions and the precise diagnosis of TRS subgroups at discharge can promote the development of an organizational culture that facilitates the treatment of patients with schizophrenia.
期刊介绍：
The central focus of the journal is on research that advances understanding of existing and new neuropsychopharmacological agents including their mode of action and clinical application or provides insights into the biological basis of psychiatric disorders and thereby advances their pharmacological treatment. Such research may derive from the full spectrum of biological and psychological fields of inquiry encompassing classical and novel techniques in neuropsychopharmacology as well as strategies such as neuroimaging, genetics, psychoneuroendocrinology and neuropsychology.
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