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Ubat antipsikotik untuk serangan awal skizofrenia

Background

Long‐term treatment with antipsychotic medications in early episode schizophrenia spectrum disorders is common, but both short and long‐term effects on the illness are unclear. There have been numerous suggestions that people with early episodes of schizophrenia appear to respond differently than those with multiple prior episodes. The number of episodes may moderate response to drug treatment.

Objectives

To assess the effects of antipsychotic medication treatment on people with early episode schizophrenia spectrum disorders.

Search methods

We searched the Cochrane Schizophrenia Group register (July 2007) as well as references of included studies. We contacted authors of studies for further data.

Selection criteria

Studies with a majority of first and second episode schizophrenia spectrum disorders comparing initial antipsychotic medication treatment with placebo, milieu, or psychosocial treatment.

Data collection and analysis

Working independently, we critically appraised records from 681studies, of which five studies met inclusion criteria. We calculated risk ratios (RR) and their 95% confidence intervals (CI) where possible. For continuous data, we calculated mean difference (MD). We calculated numbers needed to treat/harm (NNT/NNH) where appropriate.

Main results

Five studies (combined total n=998) met inclusion criteria. Four studies (n=724) provided leaving the study early data and results suggested that individuals treated with a typical antipsychotic medication are less likely to leave the study early than those treated with placebo (Chlorpromazine: 3 RCTs n=353, RR 0.4 CI 0.3 to 0.5, NNT 3.2, Fluphenaxine: 1 RCT n=240, RR 0.5 CI 0.3 to 0.8, NNT 5; Thioridazine: 1 RCT n=236, RR 0.44 CI 0.3 to 0.7, NNT 4.3, Trifulperazine: 1 RCT n=94, RR 0.96 CI 0.3 to 3.6). Two studies contributed data to assessment of adverse effects and present a general pattern of more frequent side effects among individuals treated with typical antipsychotic medications compared to placebo. One trial suggested a higher rehospitalisation rate for those receiving chlorpromazine compared to placebo (n=80, RR 2.29 CI 1.3 to 4.0, NNH 2.9). However, a higher attrition in the placebo group is likely to have introduced a survivor bias into this comparison. One study contributes data to a comparison of trifluoperazine to psychotherapy on long‐term health in favour of the trifluoperazine group (n=92, MD 5.8 CI 1.6 to 0.0); however, data from this study are also likely to contain biases due to selection and attrition. One other study contributes data to a comparison of typical antipsychotic medication to psychosocial treatment on six‐week outcome measures of global psychopathology (n=89, MD 0.01 CI ‐0.6 to 0.6) and global improvement (n=89, MD ‐0.03 CI ‐0.5 to 0.4), indicating no between‐group differences. On the whole, there is very little useable data in the few studies meeting inclusion criteria.

Authors' conclusions

With only a few studies meeting inclusion criteria, and with limited useable data in these studies, it is not possible to arrive at definitive conclusions. The preliminary pattern of evidence suggests that people with early episode schizophrenia treated with typical antipsychotic medications are less likely to leave the study early, but more likely to experience medication‐related side effects. Data are too sparse to assess the effects of antipsychotic medication on outcomes in early episode schizophrenia.

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Plain language summary

Ubat antipsikotik untuk serangan awal skizofrenia

Terdapat hanya beberapa kajian berkualiti tinggi yang membandingkan rawatan akut serangan awal skizofrenia dengan ubat antipsikotik berbanding plasebo atau rawatan psikososial. Didapati rawatan awal menggunakan ubatan bukan sahaja mengurangkan kadar geseran kajian, ianya juga menambah risiko kesan sampingan berkaitan ubat. Data terlalu terhad untuk menilai kesan‐kesan awal rawatan ubat antipsikotik ke atas individu yang mempunyai episod awal skizofrenia.