Adverse Events Unit (Research Methods Core)

不良事件单元（研究方法核心）

• 批准号: 8110774
• 负责人: CHRISTOPH U CORRELL
• 金额: $ 5.49万
• 依托单位: FEINSTEIN INSTITUTE FOR MEDICAL RESEARCH
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-27 至 2015-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8110774
• 关键词: Adherence; Adolescence; Adult; Adverse effects; Adverse event; Age; Antipsychotic Agents; Area; Biological Markers; Chronic; Clinical Research; Crows; Development; Education; Employment; Event; Family; Friends; Incidence; Intervention; Maintenance; Monitor; Outcome; Patient Noncompliance; Patients; Pattern; Perception; Pharmaceutical Preparations; Phase; Prevalence; Psychopathology; Psychotic Disorders; Recording of previous events; Relapse; Reporting; Research Methodology; Risk; Schizophrenia; Social support; Staging; Substance abuse problem; Testing; Time; Work; adverse outcome; evidence base; experience; first episode schizophrenia; follow-up; insight; medication compliance; operation

Although poor medication adherence complicates the treatment of schizophrenia at all illness stages, interventions to maximize adherence at illness outset may be particulariy fruitful. Patients' initial perceptions about antipsychotics may influence long-term adherence, and eariy phase patients with any psychotic disorder pose an enormous challenge in treatment acceptance and adherence. Groups from around the world (e.g. Coldham et al. 2002; Novak-Grubic and Tavcar 2002; Robinson et al. 2002; Mutsatsa et al. 2003; Perkins et al. 2006; Kamali et al 2006) have reported substantial rates of medication nonadherence by patients with first episode schizophrenia. The consequences of nonadherence are profound. Maintenance treatment studies (Kane et al. 1982; Crow et al. 1986; McCreadie et al. 1989; Hogarty et al. 1998 ; Robinson et al. 1999; Gitlin et al. 2001 ; Wunderrink et al. 2007) have consistently shown maintenance antipsychotic treatment lowers relapse risk for patients with early phase schizophrenia. Studies that have followed subjects long term document a pattern of repeated relapses during the eariy illness course. Robinson and colleagues (1999) found that by 5 years of follow-up, 82% of subjects had experienced one relapse; 78% of subjects who had recovered from their first relapse had a second relapse and 86% of subjects who recovered from their second relapse had a third relapse episode. Relapse risk was five times higher for patients who discontinued medication compared to those who continued medication. Although repeated relapses are detrimental to patients at all illness stages, they may have particular negative effects for eariy phase patients. Adolescence and eariy adulthood are a time when important developmental events such as finishing education, starting employment and establishing long-term relationships outside the family of origin are usually accomplished. Repeated relapses during this crucial period may disrupt successful completion of these tasks. Correlates of nonadherence in multi-episode patients include: more severe psychopathology, lack of insight, comorbid substance abuse, presence of medication side effects, an absence of social supports from family or friends, and practical barriers such as inability to afford medications. Despite the numerous studies of medication adherence in schizophrenia, information specifically about first episode patients is relatively limited. A number of factors suggest the need for separate study of recent onset patients. Due to their younger age, treatment decisions more often involve both patients and their families than is the case with multiepisode patients. Further, recent onset patients and their families lack experience with antipsychotics and with the chronic and relapsing course of schizophrenia. Their assessment of the benefits versus liabilities of antipsychotics may differ from those of multiepisode patients who have experienced the adverse consequences associated with repeated relapses.

尽管在所有疾病阶段，药物依从性差会使精神分裂症的治疗复杂化，但在疾病开始时最大化依从性的干预措施可能特别富有成果。患者对抗精神病药的最初看法可能会影响长期的依从性，并且患有任何精神病的耳相患者 在治疗接受和依从性方面构成了巨大的挑战。来自世界各地的小组（例如Coldham等，2002; Novak-Grubic and Tavcar 2002; Robinson etal。2002; Mutsatsa etal。2003; Perkins等。 2006; Kamali等，2006）报告了第一集精神分裂症患者的药物不依从性率很高。不遵守的后果是深远的。维持治疗研究（Kane等，1982; Crow等人1986; McCreadie etal。1989; Hogarty etal。1998; Robinson etal。1999; Gitlin等，2001; Wunderrink etal。2007; wunderrink etal。2007始终显示出维持抗精神病药物治疗降低了早期相位核杆菌患者的复发风险。长期遵循受试者的研究记录了在耳病疾病课程中重复复发的模式。 Robinson及其同事（1999） 发现在5年的随访中，有82％的受试者发生了一次复发。从第一次复发中恢复过来的受试者中有78％发生了第二次复发，而从第二次复发中恢复的受试者中有86％的受试者发生了第三次复发发作。中断的患者的复发风险是五倍 与那些继续用药的人相比。尽管重复复发对所有疾病阶段的患者有害，但他们可能对耳相患者产生特别的负面影响。青春期和成年期是重要的发展事件，例如完成教育，开始 通常会完成就业和建立长期关系。 在这个关键时期，重复复发可能破坏这些任务的成功完成。 多集患者不遵守的相关性包括：更严重的心理病理学，缺乏洞察力，滥用药物滥用，药物副作用的存在，没有家人或朋友的社会支持以及实践障碍，例如无法负担药物。尽管有很多研究 精神分裂症中的药物依从性，有关第一事件患者的信息相对有限。 许多因素表明需要单独研究最近的发作患者。由于年龄的年龄，治疗决策的涉及患者及其家庭的往往要比多抑制剂患者的情况更常见。此外，最近的发病患者及其家人缺乏抗精神病药的经验 精神分裂症的慢性和复发过程。他们对抗精神病药的益处与负债的评估可能与经历了与重复复发有关的不良后果的多轴测码患者的评估可能有所不同。