Peuskens J
University Centre, St. Jozef, Kortenberg, Belgium.
J Clin Psychiatry. 1999;60 Suppl 12:4-8.
Despite the introduction of antipsychotic treatment for schizophrenia, the outcome for many patients has remained poor. This is largely due to the treatment-resistant nature of schizophrenia in some patients and inadequate long-term maintenance treatment. The definition of treatment resistance remains controversial in spite of its importance. This review discusses the importance of treatment resistance and the factors affecting its definition in the light of recent advances in knowledge and treatment. A decade ago, positive symptoms were thought to be the prime outcome measure for schizophrenia and were the standard by which treatment resistance was largely assessed. More recently, however, a wider range of outcome measures has been recognized, including both negative symptoms and cognitive function. All of these outcome measures affect quality of life such that the patient may consider any outcome other than a return to premorbid levels of functioning as inadequate. Furthermore, patient responsiveness should be recognized as a continuum rather than as a dichotomy of response or nonresponse; partial response to treatment may not be accepted as satisfactory. Definitions of treatment resistance should reflect these factors. Patients may benefit from pharmacotherapy with atypical antipsychotics even if they do not meet criteria for narrowly defined treatment resistance. Although clozapine use has often been restricted to treatment-resistant patients, the benefit it bestows outweighs the potential risk of side effects in patients with less stringently defined treatment resistance.
尽管已引入针对精神分裂症的抗精神病药物治疗，但许多患者的预后仍然很差。这在很大程度上归因于某些患者精神分裂症的难治性以及长期维持治疗的不足。尽管治疗抵抗的定义很重要，但其仍存在争议。本综述根据知识和治疗方面的最新进展，讨论了治疗抵抗的重要性以及影响其定义的因素。十年前，阳性症状被认为是精神分裂症的主要疗效指标，也是评估治疗抵抗的主要标准。然而，最近人们认识到了更广泛的疗效指标，包括阴性症状和认知功能。所有这些疗效指标都会影响生活质量，以至于患者可能会认为除了恢复到病前功能水平之外的任何结果都是不理想的。此外，患者的反应性应被视为一个连续体，而不是反应或无反应的二分法；对治疗的部分反应可能不被认为是令人满意的。治疗抵抗的定义应反映这些因素。即使患者不符合狭义治疗抵抗的标准，使用非典型抗精神病药物进行药物治疗也可能使他们受益。尽管氯氮平的使用通常仅限于难治性患者，但在治疗抵抗定义不太严格的患者中，其带来的益处超过了潜在的副作用风险。
