全球各國的精神分裂症特徵與結果相當相似

作者：Caroline Cassels  
出處：WebMD醫學新聞

　　November 19, 2009 — 一項包括37國、超過17,000名精神分裂症的跨國研究發現，在症狀、藥物、雇用和性問題方面相當相似。
　　
　　這個3年的觀察型研究包括17,384名病患，這些病患正開始使用或改變他們的抗精神病藥物；結果顯示，參與者平均年紀為38歲，57%為男性，患病期間的中位數為7年，有十分之一是首次接受抗精神病藥物。
　　
　　平均而言，只有19%有有薪工作、69%居住在家扶中心、62%在前一個月有性問題。
　　
　　主要研究者、多倫多Eli Lilly Canada Inc公司的Jamie Karagianis醫師在聲明中表示，雖然有一些區域性和國家性的變異，整個研究在主要的健康、藥物和社會經濟因素方面的模式相當相似。
　　
　　他指出，這讓我們可以建立一個有價值的跨國精神分裂症人口統計學和治療資料，涵蓋10個歐洲國家、以及東亞、拉丁美洲、北非和中東的27個國家。
　　
　　由Eli Lilly Canada Inc公司贊助的此研究發表於11月的國際臨床實務期刊(International Journal of Clinical Practice)中。
　　
　　【持續的爭論】
　　根據報告，多數精神分裂症隨機控制試驗資料是根據北美病患，僅佔全球精神分裂病患者的2%。
　　
　　此外，Karagianis醫師指出，有關已開發或開發中國家的結果是否不同，一直有所爭議，這項研究納入的37個國家中，有21國是新興的或開發中的國家。
　　
　　調查目標是評估門診病患使用抗精神病藥物的花費和結果，包括開始使用或改變使用藥物，重點在強調olanzapine其他抗精神病藥物的比較。
　　
　　該研究的主要結果測量包括「臨床整體臆斷之精神分裂症(Clinical Global Impression–Schizophrenia[CGI-SCH]」嚴重度分數，使用治療精神異常的藥物、副作用、社交互動、居家和雇用狀態、自我認知的健康狀態、開始或改變使用抗精神分裂症藥物的原因。
　　
　　在開始時、第3、6、18、24和36個月時評估病患，所有參與研究的醫師自由確認病患接受的治療類型，研究贊助者未提供藥物。
　　
　　【關鍵發現】
　　研究顯示：
　　* 25.7%的研究對象服用1種以上抗精神病藥物，73.6%接受其他相關處方藥物，包括抗膽鹼藥物、抗憂鬱藥物、抗焦慮藥或安眠藥、情緒穩定劑。
　　* 10%初次服用抗精神病藥物
　　* 改變用藥的主要原因，在各調查區域皆相同，三分之二研究者引述的包括缺乏效果、無法耐受、病患要求、藥物順從性不完整。
　　* 有超過34%的病患因為過去6個月有精神分裂症而住院；例外的有拉丁美洲區域(40.8%)，其他區域的比率都相似，範圍從31.2%-36.3%。
　　* 61.5%的參與者報告有性功能不佳，例外的是東亞(33.5%)；其他區域的比率相似，範圍從57.9%-67%。
　　* CGI-SCH分數相當類似，整體平均為4.4，各區域分數範圍從3.9-4.7。正向分數平均為3.9；負向分數為4.0；憂鬱分數為3.4；認知分數為3.7。
　　* 25.8%的病患曾經試圖自殺，各區域範圍從21.7% -30.1%。
　　* 有薪雇用狀態相似，平均為19%，範圍從16.2% -22.6%；且
　　* 32.1%的研究對象有交往對象，6個區域中有5個的範圍從25.1%-38.6%。東亞的人其此一比率比其他地區更高(47.4%)。
　　
　　研究作者Karagianis、Novick、Dossenbach、Treuer、Montegomery、Walton與 Lowry是Eli Lilly的員工。Dossenbach醫師和Karagianis醫師擁有Eli Lilly股權。Haro醫師報告接受參與歐盟精神分裂症病患健康結果諮詢委員會的費用。Pecenak醫師是Eli Lilly、Astra Zeneca、Servier和Janssen Cilag的發言單位/諮商委員會成員。
　　  


Worldwide Schizophrenia Characteristics, Outcomes 'Strikingly' Similar

By Caroline Cassels
Medscape Medical News

November 19, 2009 — An international study of more than 17,000 individuals with schizophrenia from 37 countries reveals striking similarities in symptoms, medication, employment, and sexual problems.

The 3-year, observational study included 17,384 patients who were all starting to use or changing their antipsychotic medication. The results showed that participants had an average age of 38 years, and 57% were male. The median duration of illness was 7 years, and 1 in 10 was receiving antipsychotic medications for the first time.

On average, only 19% were in paid employment, 69% were living in dependent housing, and 62% reported experiencing sexual problems in the previous month.

"Although there were some regional and country variations, on the whole the study provided a strikingly similar overall pattern when it came to key health, medication, and socioeconomic factors," lead investigator Jamie Karagianis, MD, Eli Lilly Canada Inc, Toronto, Ontario, said in a statement.

"It has enabled us to build up a valuable international picture of the demographics and treatment of schizophrenia across 10 European countries and 27 countries from East Asia, Latin America, North Africa, and the Middle East," he added.

The study is published in the November issue of the International Journal of Clinical Practice and was sponsored by Eli Lilly Canada Inc.

Ongoing Debate

According to the paper, most randomized controlled trial data for schizophrenia are based on North American patients, which account for only 2% of the global schizophrenia population.

In addition, Dr. Karagianis pointed out that there has been an ongoing debate over whether developed and developing countries display different outcomes and noted that 21 of the 37 countries included in the study are emerging or developing countries.

The aim of the survey was to assess costs and outcomes of antipsychotic use in outpatients initiating use of or changing antipsychotics with an emphasis on olanzapine compared with other antipsychotic medications.

The study's main outcome measures included Clinical Global Impression–Schizophrenia (CGI-SCH) severity scores, psychotropic medication use, adverse events, social interaction, housing and employment status, self-perceived health state, and reasons for initiating use of or changing antipsychotic medications.

Patients were assessed at baseline and at 3, 6, 18, 24, and 36 months. All clinicians taking part in the study were free to determine the type of treatment their patients received, and no drugs were provided by the study sponsor.

Key Findings

The study showed:

25.7% of study participants were taking more than 1 antipsychotic and 73.6% were receiving concomitant prescription medications, including anticholinergics, antidepressants, anxiolytics or hypnotics, or mood stabilizers;
10% were taking antipsychotics for the first time;
Key reasons for changing medication were the same across all the regions surveyed, with two-thirds of the investigators citing lack of effectiveness, followed by intolerance, patient request, and incomplete adherence to the medication;
Just more than 34% of patients had been admitted to an inpatient facility because of their schizophrenia in the last 6 months. With the exception of the Latin American region (40.8%), all the other regions showed similar rates, ranging from 31.2% to 36.3%;
61.5% of participants reported sexual dysfunction, with the exception of East Asia (33.5%); the other regions reported similar levels, ranging from 57.9% to 67%;
The CGI-SCH scores were remarkably similar, with an overall average of 4.4 and regional scores ranging from 3.9 to 4.7. The positive score averaged 3.9; the negative score, 4.0; depressive score, 3.4; and cognitive score, 3.7;
25.8% of the patients had ever attempted suicide, with regional scores ranging from 21.7% to 30.1%;
Paid employment status was similar, averaging 19% and ranging from 16.2% to 22.6%; and
32.1% of participants were in a relationship, ranging from 25.1% to 38.6% in 5 of the 6 regions. People in East Asia were much more likely to be in a relationship than anywhere else (47.4%).
Study authors Karagianis, Novick, Dossenbach, Treuer, Montegomery, Walton, and Lowry are employees of Eli Lilly. Dr. Dossenbach and Dr. Karagianis are stock shareholders in Eli Lilly. Dr. Haro reports receiving compensation for participation in the European Union Schizophrenia Outpatient Health Outcomes Advisory Board. Dr. Pecenak is a member of the speaker's/advisory boards for Eli Lilly, Astra Zeneca, Servier, and Janssen Cilag.

Int J Clin Pract. 2009;63:1578-1588.