背景:精神分裂症主要是一种慢性疾病,其症状包括精神病,阴性症状和认知功能障碍。依从性差是常见的,相关的复发会损害结果。长效注射抗精神病药(LAIs)可提高治疗依从性,降低复发和再住院的可能性。在首发精神病(FEP)和早期精神分裂症(EP)患者中使用LAI可以使他们受益,然而LAI传统上保留给慢性病患者。
方法:使用三步改良的Delphi面板过程来获得对FEP和EP精神分裂症患者使用LAI的专家共识。由五名精神病学专家组成的指导委员会进行了文献综述和输入,以制定有关患者人群的陈述。不良事件管理,功能恢复。招募的德尔福过程精神科医生对他们与陈述的一致性程度进行了三轮评估(第一轮:纸质调查,1:1面试;第2-3轮:电子邮件调查)。分析规则确定声明是否进展到下一轮,以及被视为共识的协议水平。集中趋势的衡量标准(模式,平均)和变异性(四分位数范围)被报告回来,以帮助小组成员评估他们以前的反应在整个组的背景下。
结果:Delphi小组成员包括17名用LAIs治疗精神分裂症的精神科医生,在七个国家执业(法国,意大利,US,德国,西班牙,丹麦,英国)。小组成员收到了73份陈述,涵盖三个类别:患者群体;药物剂量,管理,和不良事件;以及功能恢复域和评估。55份陈述达成≥80%的共识(视为共识)。低一致性(40-79%)或极低一致性(<39%)的陈述涉及FEP和EP患者的起始剂量,管理功效丧失和突破性发作,反映了目前的证据差距。小组强调了LAI在FEP和EP患者中的益处,一致认为LAI可以降低复发的风险,再住院,和功能障碍。小组支持这些益处与症状缓解以外的多维长期功能恢复之间的联系。
结论:本德尔菲小组的研究结果支持在FEP和EP精神分裂症患者中使用LAI,无论疾病严重程度如何,复发的次数,或社会支持地位。临床医生知识的差距使得在FEP和EP患者中使用LAI的证据至关重要。
Schizophrenia is mostly a chronic disorder whose symptoms include psychosis, negative symptoms and cognitive dysfunction. Poor adherence is common and related relapse can impair outcomes. Long-acting injectable antipsychotics (LAIs) may promote treatment adherence and decrease the likelihood of relapse and rehospitalization. Using LAIs in first-episode psychosis (FEP) and early-phase (EP) schizophrenia patients could benefit them, yet LAIs have traditionally been reserved for chronic patients.
A three-step modified Delphi panel process was used to obtain expert
consensus on using LAIs with FEP and EP schizophrenia patients. A literature review and input from a steering committee of five experts in psychiatry were used to develop statements about patient population, adverse event management, and functional recovery. Recruited Delphi process psychiatrists rated the extent of their agreement with the statements over three rounds (Round 1: paper survey, 1:1 interview; Rounds 2-3: email survey). Analysis rules determined whether a statement progressed to the next round and the level of agreement deemed
consensus. Measures of central tendency (mode, mean) and variability (interquartile range) were reported back to help panelists assess their previous responses in the context of those of the overall group.
The Delphi panelists were 17 psychiatrists experienced in treating schizophrenia with LAIs, practicing in seven countries (France, Italy, US, Germany, Spain, Denmark, UK). Panelists were presented with 73 statements spanning three categories: patient population; medication dosage, management, and adverse events; and functional recovery domains and assessment. Fifty-five statements achieved ≥ 80% agreement (considered
consensus). Statements with low agreement (40-79%) or very low agreement (< 39%) concerned initiating dosage in FEP and EP patients, and managing loss of efficacy and breakthrough episodes, reflecting current evidence gaps. The panel emphasized benefits of LAIs in FEP and EP patients, with
consensus that LAIs can decrease the risk of relapse, rehospitalization, and functional dysfunction. The panel supported links between these benefits and multidimensional longer-term functional recovery beyond symptomatic remission.
Findings from this Delphi panel support the use of LAIs in FEP and EP schizophrenia patients regardless of disease severity, number of relapses, or social support status. Gaps in clinician knowledge make generating evidence on using LAIs in FEP and EP patients critical.