predictors of switching antipsychotic medications in the treatment of schizophrenia预测切换抗精神病药物治疗精神分裂症.pdfVIP

Nyhuis et al. BMC Psychiatry 2010, 10:75 /1471-244X/10/75 RESEARCH ARTICLE Open Access Predictors of switching antipsychotic medications in the treatment of schizophrenia * Allen W Nyhuis, Douglas E Faries, Haya Ascher-Svanum , Virginia L Stauffer, Bruce J Kinon Abstract Background: To identify patient characteristics and early changes in patients’ clinical status that best predict subsequent switching of antipsychotic agents in the long-term treatment of schizophrenia. Methods: This post-hoc analysis used data from a one-year randomized, open-label, multisite study of antipsychotics in the treatment of schizophrenia. The study protocol permitted switching of antipsychotics when clinically warranted after the first eight weeks. Baseline patient characteristics were assessed using standard psychiatric measures and reviews of medical records. The prediction model included baseline sociodemographics, comorbid psychiatric and non-psychiatric conditions, body weight, clinical and functional variables, as well as change scores on standard efficacy and tolerability measures during the first two weeks of treatment. Cox proportional hazards modeling was used to identify the best predictors of switching from the initially assigned antipsychotic medication. Results: About one-third of patients (29.5%, 191/648) switched antipsychotics before the end of the one-year study. There were six variables identified as the best predictors of switching: lack of antipsychotic use in the prior year, pre-existing depression, female gender, lack of substance use disorder, worsening of akathisia (as measured by the Barnes Akathisia Scale), and worsening of symptoms of depression/anxiety (subscale score on the Positive and Negative Syndrome Scale) during the first two week