Clinical Characteristics of Patients with Schizophrenia Maintained without Antipsychotics: A Cross-sectional Survey of a Case Series
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Objective: While antipsychotics are necessary for relapse prevention in the treatment of schizophrenia in general, some minority of patients may be maintained without continuous antipsychotic treatment. However, the characteristics of such patients are not well known and previous reports have not evaluated key elements such as physical comorbidities and functioning. Methods: Among 635 patients with schizophrenia who participated in a 12-year follow-up, those who were maintained without antipsychotic treatment for at least one year after the study were investigated. The patients underwent comprehensive assessments, including Positive and Negative Syndrome Scale (PANSS) for psychopathology, Cumulative Illness Rating Scale for Geriatrics (CIRS-G) for physical comorbidities, and Functional Assessment for Comprehensive Treatment of Schizophrenia (FACT-Sz), Barthel Index, and EuroQoL five dimensions (EQ5D) for function. Results: Six patients were included (mean ± standard deviation age, 66.8 ± 17.4 years; 4 inpatients). The four inpatients were old (77.8 ± 4.8 years) and chronically ill (duration of illness, 49.3 ± 12.5 years) with a high PANSS score (total score, 118.0 ± 9.8; negative syndrome subscale, 41.3 ± 6.9), low functioning (FACT-Sz, 9.8 ± 3.6; Barthel Index, 8.8 ± 9.6), and serious physical comorbidities (CIRS-G, 15.5 ± 1.1). By contrast, the two outpatients were relatively young (45.0 ± 12.0 years) and clinically in good condition (PANSS total score, 44.5 ± 0.5; Barthel Index, 100 for both; EQ5D, 0.85 ± 0.04). Conclusion: Although the number is limited, two types of patients with schizophrenia were identified who were free from ongoing antipsychotic treatment; 1) older chronic inpatients with serious physical comorbidities, and 2) younger outpatients with milder impairments. Future explorations are needed to identify those who will be successfully withdrawn from continuous antipsychotic treatment.
Abstract
Objective: While antipsychotics are necessary for relapse prevention in the treatment of schizophrenia in general, some minority of patients may be maintained without continuous antipsychotic treatment. However, the characteristics of such patients are not well known and previous reports have not evaluated key elements such as physical comorbidities and functioning. Methods: Among 635 patients with schizophrenia who participated in a 12-year follow-up, those who were maintained without antipsychotic treatment for at least one year after the study were investigated. The patients underwent comprehensive assessments, including Positive and Negative Syndrome Scale (PANSS) for psychopathology, Cumulative Illness Rating Scale for Geriatrics (CIRS-G) for physical comorbidities, and Functional Assessment for Comprehensive Treatment of Schizophrenia (FACT-Sz), Barthel Index, and EuroQoL five dimensions (EQ5D) for function. Results: Six patients were included (mean ± standard deviation age, 66.8 ± 17.4 years; 4 inpatients). The four inpatients were old (77.8 ± 4.8 years) and chronically ill (duration of illness, 49.3 ± 12.5 years) with a high PANSS score (total score, 118.0 ± 9.8; negative syndrome subscale, 41.3 ± 6.9), low functioning (FACT-Sz, 9.8 ± 3.6; Barthel Index, 8.8 ± 9.6), and serious physical comorbidities (CIRS-G, 15.5 ± 1.1). By contrast, the two outpatients were relatively young (45.0 ± 12.0 years) and clinically in good condition (PANSS total score, 44.5 ± 0.5; Barthel Index, 100 for both; EQ5D, 0.85 ± 0.04). Conclusion: Although the number is limited, two types of patients with schizophrenia were identified who were free from ongoing antipsychotic treatment; 1) older chronic inpatients with serious physical comorbidities, and 2) younger outpatients with milder impairments. Future explorations are needed to identify those who will be successfully withdrawn from continuous antipsychotic treatment.
참고문헌 (56)
- Leucht S, "Antipsychotic drugs versus placebo for relapse prevention in schizophrenia : a systematic review and metaanalysis", Lancet, 379, pp.2063~2071 (2012)
- Suzuki T, "A review on schizophrenia and relapse--a quest for user-friendly psychopharmacotherapy", Hum Psychopharmacol, 29, pp.414~426 (2014)
- Goff DC, "The long-term effects of antipsychotic medication on clinical course in schizophrenia", Am J Psychiatry, 174, pp.840~849 (2017)
- Moilanen J, "Characteristics of subjects with schizophrenia spectrum disorder with and without antipsychotic medication-a 10-year follow-up of the Northern Finland 1966 Birth Cohort study", Eur Psychiatry, 28, pp.53~58 (2013)
- Wunderink L, "Recovery in remitted first-episode psychosis at 7 years of follow-up of an early dose reduction", discontinuation or maintenance treatment strategy : long-term follow-up of a 2-year randomized clinical trial, 2013, pp.70, 913~920
- Harrow M, "Do all schizophrenia patients need antipsychotic treatment continuously throughout their lifetime? A 20-year longitudinal study", Psychol Med, 42, pp.2145~2155 (2012)
- Fenton WS, "Sustained remission in drug-free schizophrenic patients", Am J Psychiatry, 144, pp.1306~1309 (1987)
- Simpson GM, "Extrapyramidal symptoms in patients treated with risperidone", J Clin Psychopharmacol, 17, pp.194~201 (1997)
- Elie D, "Cognitive effects of antipsychotic dosage and polypharmacy : a study with the BACS in patients with schizophrenia and schizoaffective disorder", J Psychopharmacol, 24, pp.1037~1044 (2010)
- Sakurai H, "Dopamine D2 receptor occupancy and cognition in schizophrenia : analysis of the CATIE data", Schizophr Bull, 39, pp.564~574 (2013)
- Henderson DC, "Pathophysiological mechanisms of increased cardiometabolic risk in people with schizophrenia and other severe mental illnesses", Lancet Psychiatry, 2, pp.452~464 (2015)
- Stahl SM, "Which comes first: atypical antipsychotic treatment or cardiometabolic risk?", Acta Psychiatr Scand, 119, pp.171~179 (2009)
- De Hert M, "Metabolic and cardiovascular adverse effects associated with antipsychotic drugs", Nat Rev Endocrinol, 8, pp.114~126 (2011)
- Ray WA, "Atypical antipsychotic drugs and the risk of sudden cardiac death", N Engl J Med, 360, pp.225~235 (2009)
- Takeuchi H, "Antipsychotic treatment for schizophrenia in the maintenance phase : a systematic review of the guidelines and algorithms", Schizophr Res, 134, pp.219~225 (2012)
- Shimomura Y, "Antipsychotic treatment in the maintenance phase of schizophrenia : an updated systematic review of the guidelines and algorithms", Schizophr Res, 215, pp.8~16 (2020)
- Hofer A, "Quality of life in schizophrenia and bipolar disorder : the impact of symptomatic remission and resilience", Eur Psychiatry, 46, pp.42~47 (2017)
- Palmer BW, "Wellness within illness : happiness in schizophrenia", Schizophr Res, 159, pp.151~156 (2014)
- Torgalsbøen AK, "Sustaining full recovery in schizophrenia after 15 years: does resilience matter?", Clin Schizophr Relat Psychoses, 5, pp.193~200 (2012)
- Mizuno Y, "Clinical and biological correlates of resilience in patients with schizophrenia and bipolar disorder : a cross-sectional study", Schizophr Res, 175, pp.148~153 (2016)
- Tomita M, "Prevalence and indications of atypical antipsychotics", 12th Academic Meeting of Japanese Society of Clinical Neuropsychopharmacology (2002)
- Kay SR, "The positive and negative syndrome scale(PANSS)for schizophrenia", Schizophr Bull, 13, pp.261~276 (1987)
- Simpson GM, "A rating scale for extrapyramidal side effects", Acta Psychiatr Scand Suppl, 212, pp.11~19 (1970)
- Barnes TR, "A rating scale for drug-induced akathisia", Br J Psychiatry, 154, pp.672~676 (1989)
- Guy W, "ECDEU Assessment manual for psychopharmacology, revised", pp.218~222 (1976), National Institute of Mental Health
- Suzuki T, "Novel rating scales for schizophrenia-Targeted Inventory on Problems in Schizophrenia(TIP-Sz)and Functional Assessment for Comprehensive Treatment of Schizophrenia(FACT-Sz)", Schizophr Res, 106, pp.328~336 (2008)
- Mahoney FI, "Functional evaluation : the Barthel index", Md State Med J, 14, pp.61~65 (1965)
- Miller MD, "Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale", Psychiatry Res, 41, pp.237~248 (1992)
- "Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group", Psychol Med, 28, pp.551~558 (1998)
- Tazaki M, (1997), Kaneko Shobo
- EuroQol Group, "EuroQol--a new facility for the measurement of health-related quality of life", Health Policy, 16, pp.199~208 (1990)
- Wagnild GM, "Development and psychometric evaluation of the Resilience Scale", J Nurs Meas, 1, pp.165~178 (1993)
- Nishi D, "Reliability and validity of the Japanese version of the Resilience Scale and its short version", BMC Res Notes, 3, pp.310~ (2010)
- Peterman AH, "Measuring spiritual well-being in people with cancer : the functional assessment of chronic illness therapy--Spiritual Well-being Scale(FACIT-Sp)", Ann Behav Med, 24, pp.49~58 (2002)
- Noguchi W, "Reliability and validity of the Functional Assessment of Chronic Illness Therapy-Spiritual(FACIT-Sp)for Japanese patients with cancer", Support Care Cancer, 12, pp.240~245 (2004)
- Harrow M, "Factors involved in outcome and recovery in schizophrenia patients not on antipsychotic medications : a 15-year multifollow-up study", J Nerv Ment Dis, 195, pp.406~414 (2007)
- Koreki A, "Clinical and demographic characteristics associated with postural instability in patients with schizophrenia", J Clin Psychopharmacol, 31, pp.16~21 (2011)
- Dziewas R, "Neuroleptic-induced dysphagia : case report and literature review", Dysphagia, 22, pp.63~67 (2007)
- Ashburn A, "A community-dwelling sample of people with Parkinson’s disease : characteristics of fallers and non-fallers", Age Ageing, 30, pp.47~52 (2001)
- Nielsen J, "Risk factors for ileus in patients with schizophrenia", Schizophr Bull, 38, pp.592~598 (2012)
- De Hert M, "Second-generation antipsychotics and constipation : a review of the literature", Eur Psychiatry, 26, pp.34~44 (2011)
- van der Maarel-Wierink CD, "Risk factors for aspiration pneumonia in frail older people : a systematic literature review", J Am Med Dir Assoc, 12, pp.344~354 (2011)
- Rabinowitz J, "Association of prominent positive and prominent negative symptoms and functional health, well-being, healthcare-related quality of life and family burden : a CATIE analysis", Schizophr Res, 150, pp.339~342 (2013)
- Suzuki T, "Successful withdrawal from antipsychotic treatment in elderly male inpatients with schizophrenia--description of four cases and review of the literature", Psychiatry Res, 220, pp.152~157 (2014)
- Remington G, "Guidelines for the pharmacotherapy of schizophrenia in adults", Can J Psychiatry, 62, pp.604~616 (2017)
- Grover S, "Clinical practice guidelines for management of schizophrenia", Indian J Psychiatry, 59(Suppl 1), pp.S19~S33 (2017)
- Galletly C, "Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders", Aust N Z J Psychiatry, 50, pp.410~472 (2016)
- National Collaborating Centre for Mental Health, "Psychosis and schizophrenia in adults: treatment and management: updated edition 2014" (2014), National Institute for Health and Care Excellence
- Scottish Intercollegiate Guidelines Network, "Management of schizophrenia. A national clinical guideline", Scottish Intercollegiate Guidelines Network, ~ (2013)
- Hasan A, "World Federation of Societies of Biological Psychiatry(WFSBP)guidelines for biological treatment of schizophrenia, part 2 : update 2012 on the long-term treatment of schizophrenia and management of antipsychotic-induced side effects", World J Biol Psychiatry, 14, pp.2~44 (2013)
- Sakurai H, "Pharmacological treatment of schizophrenia : Japanese expert consensus", Pharmacopsychiatry, 54, pp.60~67 (2021)
- Bowtell M, "Clinical and demographic predictors of continuing remission or relapse following discontinuation of antipsychotic medication after a first episode of psychosis. A systematic review", Schizophr Res, 197, pp.9~18 (2018)
- Brian J. Miller, "Second-Generation Antipsychotic Discontinuation in First Episode Psychosis: An Updated Review", Clinical Psychopharmacology and Neuroscience, 9(2), pp.45~53 (2011), 대한정신약물학회
- Tani H, "Clinical characteristics of patients with schizophrenia who successfully discontinued antipsychotics : a literature review", J Clin Psychopharmacol, 38, pp.582~589 (2018)
- Perkins DO, "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", J Clin Psychiatry, 69, pp.106~113 (2008)
- Zipursky RB, "Risk of symptom recurrence with medication discontinuation in first-episode psychosis : a systematic review", Schizophr Res, 152, pp.408~414 (2014)