ABSTRACT

Background

The open dialogue (OD) approach includes the need-adapted use of psychiatric medication in treating first-episode psychosis (FEP), but there is limited information on how psychiatric medications are actually used in OD-based services. This study aims to analyse long-term medication dispensing patterns among FEP cohort treated according to the OD.

Methods

The OD cohort consisted of people who received treatment for FEP in the Finnish Western Lapland catchment area at a time of OD implementation (n=61). The comparison group included people whose FEP treatment commenced outside the catchment area during the mid-1990s (n=1378). Data were gathered from national registers from onset to the end of the 10-year follow-up or death. A non-confirmatory descriptive comparison was performed to evaluate the usage patterns and cumulative exposure to psychiatric medication.

Results

Under OD, a smaller proportion had been dispensed benzodiazepines, antidepressants, and neuroleptics. Persons who had received these medications did not differ in cumulative exposure. In both groups, most of those who received neuroleptics in the first follow-up years continued using medication throughout follow-up.

Discussion

OD may assist in detecting FEP patients who can manage without neuroleptics, thus minimizing iatrogenic effects. Due to the observational design, further studies are required to confirm this hypothesis.

中文翻译：

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需要在精神病的公开对话方法中调整药物的使用：一项描述性纵向队列研究

摘要

背景

开放对话 (OD) 方法包括根据需要使用精神科药物来治疗首发精神病 (FEP)，但关于如何在基于 OD 的服务中实际使用精神科药物的信息有限。本研究旨在分析根据 OD 治疗的 FEP 队列中的长期药物配药模式。

方法

OD 队列由在 OD 实施时在芬兰西拉普兰流域接受 FEP 治疗的人组成 ( n= 61)。对照组包括 20 世纪 90 年代中期在学区外开始接受 FEP 治疗的人 ( n= 1378)。数据是从国家登记册中收集的，从发病到 10 年随访或死亡结束。进行了非验证性描述性比较，以评估精神药物的使用模式和累积暴露量。

结果

在 OD 下，一小部分人被分配了苯二氮卓类药物、抗抑郁药和精神安定药。接受这些药物治疗的人的累积暴露量没有差异。在这两组中，大多数在第一个随访年接受抗精神病药物的患者在整个随访期间继续使用药物。

讨论

OD 可能有助于检测无需服用抗精神病药即可治疗的 FEP 患者，从而最大限度地减少医源性影响。由于观察设计，需要进一步研究来证实这一假设。