No CrossRef data available.
Article contents
Estudio de dos años sobre prevención de las recaídas con un nuevo programa de educación en pacientes esquizofrénicos tratados con el mismo antipsicótico
Published online by Cambridge University Press: 01 April 2008
Resumen
No esta claro si la psicoeducación del paciente aumenta la aceptación de los tratamientos antipsicóticos y reduce el número de recaídas. Aquí investigamos el impacto de un nuevo programa psicoeducativo (SOLEDUC®) sobre la tasa de recaídas al año y a los dos años (variable primaria) y varias evaluaciones clinicas (variables secundarias). Éste fue un ensayo clínico multicéntrico francés (51 centros) de Fase IV, abierto, controlado y aleatorizado, compuesto de dos grupos paralelos: grupo Soleduc (N = 111) y grupo de control (N = 109). Todos los sujetos recibieron una dosis variable durante el período de 2 años del mismo antipsicótico (amisulprida). Soleduc fue un programa de 7 sesiones de 1 hora, que se presentó tres veces (inicialmente, a los 6 meses y a los 12 meses). Los pacientes del grupo de control recibieron una educación psicosocial inespecífica durante un período equivalente de tiempo. Para analizar las recaídas se usaron los modelos de Andersen-Gill (AG) y Prentice, Williams y Peterson (PWP). Los pacientes del grupo Soleduc asistieron a 14,8 ± 6,1 sesiones (media ± DE), incluidos 17 pacientes que nunca asistieron a una sesión. El análisis de intención de tratar demostró que recayeron menos pacientes del grupo Soleduc que del grupo de control (21,6% frente a 28,4% después de 1 año y 84,4% frente a 90,8% a los 2 años), pero las diferencias no fueron estadísticamente significativas. El riesgo de recaida se redujo significativamente en pacientes que siguieron al menos 7 módulos (p = 0,015, test AG; p < 0,001, test PWP). En conclusión, no se encontró ninguna diferencia significativa en las tasas de recaida entre los pacientes que realizaron el programa Soleduc y el grupo de control. Fue necesaria la asistencia a 7 de 21 sesiones del programa, al menos, para que hubiera una prevencioó leve pero significativa de las recaídas a los dos años en pacientes con esquizofrenia. Son necesarios otros estudios bien diseñados para evaluar el impacto médico de los programas de educación del paciente.
- Type
- Artículo original
- Information
- Copyright
- Copyright © European Psychiatric Association 2008
References
Bibliografía
[1]Achard, SChignon, JMPoirier-Littre, MFGalinowski, APringuey, DVan Os, J, et al. Social adjustment and depression: value of the SASSR (Social Adjustment Scale Self-Report). Encephale 1995; 21: 107-16.Google Scholar
[2] American Psychiatric Association. Practice guideline for the treatment of patients with schizophrenia. In: 2nd ed. Washington: Association AP, American Psychiatric Association; 2004.Google Scholar
[3]Andersen, PKGili, RD. Cox’s regression model for counting processes: a large sample study. Ann Statist 1982; 10: 1100-20.CrossRefGoogle Scholar
[4]Ascher-Svanum, HWhitesel, J. Randomized controlled study of two styles of group patient education about schizophrenia. Psychiatric Services 1999; 50: 926-30.CrossRefGoogle ScholarPubMed
[5]Boczkowski, JAZeichner, ADeSanto, N. Neuroleptic compliance among chronic schizophrenic outpatients: an intervention outcome report. J Consult Clin Psychol 1985; 53: 666-71.CrossRefGoogle ScholarPubMed
[6]Boyer, PLecrubier, YPuech, AJDewailly, JAubin, F. Treatment of negative symptoms in schizophrenia with amisulpride. Br J Psychiatry 1995; 166: 68–72.CrossRefGoogle ScholarPubMed
[7]Coukell, AJSpencer, CM, Benfield Amisulpride P. A review of its pharmacodynamic and pharmacokinetic properties and therapeutic efficacy in the management of schizophrenia. Adis Int CNS Drugs 1996; 6: 237-56.CrossRefGoogle Scholar
[8]Delcker, ASchoon, MLOczkowski, BGaertner, HJ. Amisulpride versus haloperidol in treatment of schizophrenic patients—results of a doubleblind study. Pharmapsychiatry 1990; 23: 125-30.CrossRefGoogle Scholar
[9]Dodds, FRebair-Brown, AParsons, S. A systematic review of randomized controlled triais that attempt to identify interventions that improve patient compliance with prescribed antipsychotic medicadon. Clin Effecdveness Nurs 2000; 4(2): 47–53.CrossRefGoogle Scholar
[10]Dolder, CRLacro, JLeckband, SJeste, DV. Interventions to improve antipsychotic medicadon adherence: review of recent literature. J Clin Psychopharmacol 2003; 23: 389-99.CrossRefGoogle ScholarPubMed
[11]Fleurot, OBech, PTurjanski, S. Amisulpride versus risperidone in the treatment of acute schizophrenia. Biol Psychiatry 1997;42:S1–297.CrossRefGoogle Scholar
[12]Goldstein, MJ. Psychoeducation and relapse prevention. Int J Psychopharmacol 1995; 9(Suppl.5): 59–69.CrossRefGoogle ScholarPubMed
[13]Guillard-Bouhet, NLafay, NJourdain, MSenon, JL. Transversal study of the psychosocial rehabilitation and the quality of life of 75 schizophrenics under classical neuroleptics or atypical antipsychotic neuroleptics. Encephale 2005; 31: 653-65.CrossRefGoogle ScholarPubMed
[14]Guy, W. Clinical global impression. In: Health NIoM, editor. ECDEU assessment manual for psychopharmacology. Rockville, MD: National Institute of Mental Health; 1976.Google Scholar
[15]Herz, MILamberd, JSMintz, JScott, RO’Dell, SPMcCartan, L, et al. A program for relapse prevention in schizophrenia—a controlled study. Arch Gen Psychiatry 2000; 57: 277-83.CrossRefGoogle ScholarPubMed
[16]Hillert, APhillip, MGattaz, WFWetzel, HGrunder, GSauer, H, et al. Amisulpride vs Flupenthixol in the treatment of schizophrenia with predominant positive symptomatology. Neuropsychopharmacology 1994; 10(3S, part 2): S31. 1994. 31S.Google Scholar
[17]Kay, SRFiszbein, AOpler, LA. The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr Bull 1987; 13:261-75.CrossRefGoogle Scholar
[18]Klingberg, SBuchkremer, GHolle, R, Schulze Monking H, Hornung WP. Differential therapy effects of psychoeducational psychotherapy for schizophrenic patients—results of a 2-year follow-up. Eur Arch Psychiatry Clin Neurosci 1999; 249: 66–72.CrossRefGoogle ScholarPubMed
[19]Loo, HPoirier Littre, MFTheron, MRein, WFleurot, O. Amisulpride versus placebo in the medium term treatment of the negative symptoms of schizophrenia. Br J Psychiatry 1997; 170: 18–22.CrossRefGoogle ScholarPubMed
[20]McFarlane, WRLink, BDushay, RMarchal, JCrilly, J. Psychoeducational multiple family groups: four-year relapse outcome in schizophrenia. Fam Process 1995; 34: 127-44.CrossRefGoogle Scholar
[21]Mclntosh, AMConlon, LLawrie, SMStanfield, AC. Compliance therapy for schizophrenia. Cochrane Database Syst Rev 2006.CrossRefGoogle Scholar
[22]Merinder, LB. Patient education in schizophrenia: a review. Acta Psychiatr Scand 2000; 102(2): 98–106.CrossRefGoogle ScholarPubMed
[23]Motlova, LSpaniel, FVanurova, IKlaschkal, J. Psychoeducation and relapse of schizophrenia. Eur Psychiatry 2000;15(Suppl. 2):s349.CrossRefGoogle Scholar
[24]Nose, MBarbui, CGray, RTansella, M. Clinical interventions for treatment non-adherence in psychosis: meta-analysis. Br J Psychiatry 2003 September 1; 183(3): 197–206.CrossRefGoogle ScholarPubMed
[25]Novak-Gubric, VTavcar, R. Predictors of noncompliance in males with first-episode schizophrenia, schizophreniform and schizoaffective disorder. Eur Psychiatry 2002; 17: 148-54.CrossRefGoogle Scholar
[26]Paillere-Martinot, MLLecrubier, YMardnot, JLAubin, F. Improvement of some schizophrenic deficit symptoms with low doses of amisulpride. Am J Psychiatry 1995; 152: 130-3.Google ScholarPubMed
[27]Pekkala, EMerinder, L. Psychoeducation for schizophrenia. Cochrane Database Syst Rev 2002.CrossRefGoogle Scholar
[28]Pitschel-Walz, GLeucht, SBauml, JKissling, WEngel, RR. The effect of family interventions on relapse and rehospitalization in schizophrenia—a meta-analysis. Schizophr Bull 2001; 27: 73–92.CrossRefGoogle ScholarPubMed
[29]Prentice, RLWilliams, BJPeterson, AV. On the regression analysis of multivariate failure time data. Biometrika 1981; 68: 373-9.CrossRefGoogle Scholar
[30]Puschner, BBorn, AGiessler, AHelm, HLeese, MBindman, JP, et al. Adherence to medication and quality of life in people with schizophrenia: results of a European multicenter study. J Nerv Ment Dis 2006; 194: 746-52.CrossRefGoogle ScholarPubMed
[31]Robert, PBraccini, TVitali, PDarcourt, G. Echelle d’aptitude psychosociale (EAPS). Presentation et validation. Psychologie Medicale 1987; 19: 1761-5.Google Scholar
[32]Rund, BRMoe, LSollien, TFjell, ABorchgrevink, THallert, M, et al. The Psychosis Project: outcome and cost-effectiveness of a psychoeducational treatment programme for schizophrenic adolescents. Acta Psychiatr Scand 1994; 89: 211-8.CrossRefGoogle ScholarPubMed
[33]Sciolla, APatterson, TLWetherell, JLMcAdams, LAJeste, DV. Functioning and well-being of middle-aged and older patients with schizophrenia: measurement with the 36-item short-form (SF-36) health survey. Am J Geriatr Psychiatry 2003; 11: 629-37.Google ScholarPubMed
[34]Weiden, PRapkin, BMott, TZygmunt, AGoldman, DFlorvitz-Lennon, M, et al. Rating of Medication Influences (ROMI) scale in schizophrenia. Schizophr Bull 1994; 20: 297–310.CrossRefGoogle Scholar
[35]Yamada, KWatanabe, KNeinoto, NFujita, HChikaraishi, CYamanchi, K, et al. Prediction of medication noncompliance in outpatients with schizophrenia: 2-year follow-up study. Psychiatry Res 2006; 141: 61-9.CrossRefGoogle ScholarPubMed
[36]Zygmunt, AOlfson, MBoyer, CAMechanic, D. Interventions to improve medication adherence in schizophrenia. Am J Psychiatry 2002 October 1:159(10): 1653-64.CrossRefGoogle Scholar