妄想性斜長症患者における非定型抗精神病薬と精神療法の有効性の評価-寛解期間に基づいて

EVALUATION OF THE EFFICACY OF ATYPICAL ANTIPSYCHOTIC DRUGS AND PSYCHOTHERAPY IN PATIENTS WITH PARANOID SCHIZOPHRENIA BASED ON THE DURATION OF REMISSION.

• О Mruh
• S Rymsha
• V Mruh

抄録

寛解期間（Duration of Remission: DR）とは、処方された治療がうまくいかずに終了した証拠と考えられる再入院のリスクに相当するものである。処方の有効性の判断基準としてのDR情報性のエビデンスは、観察期間中の再入院患者のDR値の分布である。本研究の目的は、妄想性統合失調症患者に対して非定型抗精神病薬と精神療法を処方した場合の有効性の基準として寛解期間を分析することである。第1群は非定型抗精神病薬を投与された患者、第2群は非定型抗精神病薬と精神療法的コルテックス（PC）を投与された患者、対照群第1群は典型的な抗精神病薬を投与された患者、対照群第2群は典型的な抗精神病薬とPCを投与された患者の4つのグループを編成し、それぞれのグループの患者数は164名であった。被検者数は164名、平均年齢は29.25±13.5歳、妄想性統合失調症と診断された患者数は118名、統合失調症の症状を伴う急性多型精神病性障害と診断された患者数は46名であった。平均罹病期間は2.7±2.1年であった。統計的トビットモデルを用いて、抗精神病薬、精神療法、DRの併用の有効性を客観化することができた。トビットモデルを用いて、仮説の力、すなわち、比較された治療法の有効性の既存の差異を決定するためのこのモデルの可能性を検定した（Rosenbaum and Rubin, 1983; Wooldridge, J.M., 2012）。治療の有効性は、患者による寛解期間の持続期間および疾患の再発による再入院のリスクの指標によって評価された。その結果、観察期間中に再入院する患者がいることが明らかになり、最初の100日間の入院率が最も高かった。その結果，典型的な抗精神病薬を服用している患者（44例）は，非典型的な抗精神病薬を服用している患者（12例）と比較して，再入院の割合が高いことが明らかになった。また，検閲対象108例中，非定型抗精神病薬服用者（70例）は典型的抗精神病薬服用者（38例）と比較して寛解が延長した症例が明らかに優勢であった。その結果，典型的抗精神病薬と非典型的抗精神病薬を服用した患者は，同じ期間で寛解に至るが，その質は異なると判断された。非定型抗精神病薬とPCの処方によるDRの指標は，定型抗精神病薬に比べて有意に高く，1人当たりのDRの積分差は140日であった。非定型抗精神病薬の処方による再入院リスクは典型的な抗精神病薬の処方と比較して平均87.8％減少した。

Duration of remission (DR) is the equivalent of the risk of re-hospitalization, which is considered as evidence of unsuccessful completion of the prescribed treatment. The evidence of DR informativeness as a criterion for effectiveness of prescriptions is distribution of DR values among patients with re-hospitalization during the observation period. The aim of the study is to analyse the duration of remission as a criterion for the effectiveness of prescribing atypical antipsychotic drugs and psychotherapy for patients with paranoid schizophrenia. 4 groups of patients were formed: the study group No. 1 includes patients who received atypical antipsychotic drugs; the study group No. 2 includes patients who received atypical antipsychotic drugs and psychotherapeutic cortrection (PC); the control group No. 1 includes patients receiving typical antipsychotic drugs; the control group No. 2 includes patients who received typical antipsychotic drugs and PC. The total number of examined patients was 164 people, the average age was 29.25±13.5 years, the number of patients with a diagnosis of paranoid schizophrenia was 118, with a diagnosis of acute polymorphic psychotic disorder with symptoms of schizophrenia - 46. The average duration of the disease was 2.7±2.1 years. The statistical tobit model made it possible to objectify the results of the effectiveness of the combination of antipsychotic drugs, psychotherapy, and DR by the studied patients. We used the tobit model to test the power of hypotheses, i.e., the possibility of this model to determine the existing differences in the effectiveness of the compared treatment methods (Rosenbaum and Rubin, 1983; Wooldridge, J.M., 2012). The effectiveness of the treatment was evaluated by indicators of duration of the remission period by the patients and the risk of re-hospitalization due to disease relapse. We observed a clear dynamic of some patients to re-hospitalization during the observation period with the highest hospitalization rates in the first 100 days. Evidence of the tests powers was a clear prevalence of cases of re-hospitalization by the patients taking typical antipsychotic drugs (44 cases) compared with those among patients receiving atypical ones (12). There was a clear predominance of cases of prolonged remission by the patients who took atypical antipsychotic drugs (70) compared with those who received typical ones (38) among 108 of censored ones. It was determined that patients who took typical and atypical antipsychotic drugs entered remission with the same period, but its quality was different. It was found that the indices of DR by prescription of atypical antipsychotic drugs and PC were significantly higher compared with those of typical antipsychotic drugs - the integral difference in DR per patient was 140 days. The risk of re-hospitalization due to prescription of atypical antipsychotic drugs decreases on average by 87.8% compared with prescription of the typical ones, that is, prescription of atypical antipsychotic drugs significantly increases DR compared with prescription of typical antipsychotic drugs.