Predictors of switching antipsychotic medications in the treatment of schizophrenia 英文参考文献.docVIP

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Predictors of switching antipsychotic medications in the treatment of schizophrenia 英文参考文献.doc

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Predictors of switching antipsychotic medications in the treatment of schizophrenia 英文参考文献

Nyhuisetal.BMCPsychiatry2010,10:75 /1471-244X/10/75 RESEARCH ARTICLE OpenAccess Predictorsofswitchingantipsychoticmedications inthetreatmentofschizophrenia AllenWNyhuis,DouglasEFaries,HayaAscher-Svanum*,VirginiaLStauffer,BruceJKinon Abstract Background:Toidentifypatientcharacteristicsandearlychangesinpatients’clinicalstatusthatbestpredict subsequentswitchingofantipsychoticagentsinthelong-termtreatmentofschizophrenia. Methods:Thispost-hocanalysisuseddatafromaone-yearrandomized,open-label,multisitestudyof antipsychoticsinthetreatmentofschizophrenia.Thestudyprotocolpermittedswitchingofantipsychoticswhen clinicallywarrantedafterthefirsteightweeks.Baselinepatientcharacteristicswereassessedusingstandard psychiatricmeasuresandreviewsofmedicalrecords.Thepredictionmodelincludedbaselinesociodemographics, comorbidpsychiatricandnon-psychiatricconditions,bodyweight,clinicalandfunctionalvariables,aswellas changescoresonstandardefficacyandtolerabilitymeasuresduringthefirsttwoweeksoftreatment.Cox proportionalhazardsmodelingwasusedtoidentifythebestpredictorsofswitchingfromtheinitiallyassigned antipsychoticmedication. Results:Aboutone-thirdofpatients(29.5%,191/648)switchedantipsychoticsbeforetheendoftheone-year study.Thereweresixvariablesidentifiedasthebestpredictorsofswitching:lackofantipsychoticuseintheprior year,pre-existingdepression,femalegender,lackofsubstanceusedisorder,worseningofakathisia(asmeasuredby theBarnesAkathisiaScale),andworseningofsymptomsofdepression/anxiety(subscalescoreonthePositiveand NegativeSyndromeScale)duringthefirsttwoweeksofantipsychotictherapy. Conclusions:Switchingantipsychoticsappearstobeprevalentinthenaturalistictreatmentofschizophreniaand canbepredictedbyasmallanddistinctsetofvariables.Interestingly,worseningofanxietyanddepressive symptomsandofakathisiafollowingtwoweeksoftreatmentwereamongthemorerobustpredictorsof subsequentswitchingofantipsychotics. Background Reasonsforantipsychoticswitchingordiscontinuation Antipsychotic medications aremainstays