PDF(Pubmed)
Abstract：
UNASSIGNED: Based on the need-adapted approach, delaying antipsychotics could help identify first-episode psychosis (FEP) adolescents who might not require them. However, some individuals might need antipsychotics, and postponing could harm their prognosis. This nationwide register-based follow-up aimed to test these two hypotheses.
UNASSIGNED: All adolescents aged 13-20 with a psychotic disorder (ICD-10 codes: F20-F29) in Finland between 2003 and 2013 were identified (n = 6354) from national registers. For each case, a fixed 1825-day follow-up period was established from the onset of psychosis or until death. The outcome was considered \"good\" if adolescents did not die and had not received psychiatric treatment and/or disability allowances during the final year of follow-up. Testing the first hypothesis involved all antipsychotic treatment-naïve adolescents with FEP (n = 3714). The second hypothesis was tested with a sub-sample of only those who had received antipsychotics during follow-up (n = 3258). To account for baseline confounders, hypotheses were tested via a stabilized inverse probability of treatment weighted generalized linear models with logit link function.
UNASSIGNED: Immediate antipsychotic treatment after the onset of psychosis was associated with poor 5-year outcome (adjusted odds ratio [aOR]: 1.8, 95% CI: 1.6-2.1). There was no statistically significant association between antipsychotic postponement and treatment outcome in those who eventually received antipsychotic treatment (aOR: 1.02, 95% CI: 0.7-1.2, P: .8), thus not providing support for second hypothesis.
UNASSIGNED: There is a significant subgroup of adolescent with psychosis who do not require immediate antipsychotic treatment. A more robust design is needed to evaluate the causality of the observed association.
UNASSIGNED: All adolescents aged 13-20 with a psychotic disorder (ICD-10 codes: F20-F29) in Finland between 2003 and 2013 were identified (n = 6354) from national registers. For each case, a fixed 1825-day follow-up period was established from the onset of psychosis or until death. The outcome was considered \"good\" if adolescents did not die and had not received psychiatric treatment and/or disability allowances during the final year of follow-up. Testing the first hypothesis involved all antipsychotic treatment-naïve adolescents with FEP (n = 3714). The second hypothesis was tested with a sub-sample of only those who had received antipsychotics during follow-up (n = 3258). To account for baseline confounders, hypotheses were tested via a stabilized inverse probability of treatment weighted generalized linear models with logit link function.
UNASSIGNED: Immediate antipsychotic treatment after the onset of psychosis was associated with poor 5-year outcome (adjusted odds ratio [aOR]: 1.8, 95% CI: 1.6-2.1). There was no statistically significant association between antipsychotic postponement and treatment outcome in those who eventually received antipsychotic treatment (aOR: 1.02, 95% CI: 0.7-1.2, P: .8), thus not providing support for second hypothesis.
UNASSIGNED: There is a significant subgroup of adolescent with psychosis who do not require immediate antipsychotic treatment. A more robust design is needed to evaluate the causality of the observed association.
摘要：
■基于需求适应方法，延迟使用抗精神病药物有助于识别可能不需要的首发精神病(FEP)青少年.然而,有些人可能需要抗精神病药，推迟可能会损害他们的预后。这项基于全国注册的后续行动旨在检验这两个假设。
■从国家登记册中确定了2003年至2013年间芬兰13-20岁患有精神病（ICD-10代码：F20-F29）的所有青少年（n=6354）。对于每种情况，从精神病发作或直至死亡建立了固定的1825天随访期.如果青少年在随访的最后一年没有死亡并且没有接受精神病治疗和/或残疾津贴，则结果被认为是“良好”。测试第一个假设涉及所有抗精神病治疗的未使用FEP的青少年（n=3714）。第二个假设仅在随访期间接受抗精神病药的子样本中进行了测试（n=3258）。为了解释基线混杂因素，通过具有logit链接函数的治疗加权广义线性模型的稳定逆概率检验假设。
精神病发作后立即接受抗精神病药物治疗与5年预后不良相关（校正比值比[aOR]：1.8，95%CI：1.6-2.1）。在最终接受抗精神病药物治疗的患者中，抗精神病药物推迟治疗与治疗结果之间没有统计学上的显着关联（aOR：1.02，95％CI：0.7-1.2，P：.8），因此不能为第二种假设提供支持。
■有一个重要的青少年精神病亚组，不需要立即抗精神病药物治疗。需要更稳健的设计来评估观察到的关联的因果关系。
■从国家登记册中确定了2003年至2013年间芬兰13-20岁患有精神病（ICD-10代码：F20-F29）的所有青少年（n=6354）。对于每种情况，从精神病发作或直至死亡建立了固定的1825天随访期.如果青少年在随访的最后一年没有死亡并且没有接受精神病治疗和/或残疾津贴，则结果被认为是“良好”。测试第一个假设涉及所有抗精神病治疗的未使用FEP的青少年（n=3714）。第二个假设仅在随访期间接受抗精神病药的子样本中进行了测试（n=3258）。为了解释基线混杂因素，通过具有logit链接函数的治疗加权广义线性模型的稳定逆概率检验假设。
精神病发作后立即接受抗精神病药物治疗与5年预后不良相关（校正比值比[aOR]：1.8，95%CI：1.6-2.1）。在最终接受抗精神病药物治疗的患者中，抗精神病药物推迟治疗与治疗结果之间没有统计学上的显着关联（aOR：1.02，95％CI：0.7-1.2，P：.8），因此不能为第二种假设提供支持。
■有一个重要的青少年精神病亚组，不需要立即抗精神病药物治疗。需要更稳健的设计来评估观察到的关联的因果关系。
