Fraser Richard, Berger Gregor, McGorry Patrick
ORYGEN, Youth Health, Melbourne, Victoria.
Aust Fam Physician. 2006 May;35(5):323-7.
To optimise the management of emerging psychotic disorders in young people, close collaboration between the general practitioner and youth friendly specialist mental health services is favourable. Ideally, a multidisciplinary team including individual case management with expertise in early intervention should treat these patients for the initial 2-5 years. However, only a few areas across Australia currently provide this type of specialised service. Most GPs will at some point be faced with the reality of personally managing young patients with emerging psychotic disorders on their own, sometimes with very limited support.
This article summarises key issues for the optimal management of emerging psychotic disorders, with a particular focus on the role of the GP.
Once an emerging psychotic disorder is confirmed, the engagement of the young person into therapy is the primary target. Ideally therapy integrates not only the patient, but also their family, carers and friends. General practitioners need to inform patients about the nature of the emerging psychotic illness, manage related comorbidities such as substance abuse, and initiate antipsychotic medication to avoid any unnecessary delay in resolution of symptoms. It is important to monitor the patient on a regular basis even after symptom recovery as up to 80% of cases that cease medication will relapse within 5 years.
为了优化对青少年新发精神病性障碍的管理，全科医生与青少年友好型专业心理健康服务机构之间密切合作是有益的。理想情况下，一个多学科团队，包括具备早期干预专业知识的个案管理，应该在最初的2至5年对这些患者进行治疗。然而，目前澳大利亚只有少数地区提供这种类型的专业服务。大多数全科医生在某些时候将不得不面对独自管理患有新发精神病性障碍的年轻患者的现实，有时得到的支持非常有限。
本文总结了新发精神病性障碍优化管理的关键问题，特别关注全科医生的作用。
一旦确诊为新发精神病性障碍，促使年轻人参与治疗是首要目标。理想情况下，治疗不仅要纳入患者，还要包括他们的家人、照顾者和朋友。全科医生需要告知患者新发精神病性疾病的性质，管理相关的合并症，如药物滥用，并启动抗精神病药物治疗，以避免症状缓解出现任何不必要的延迟。即使在症状恢复后，定期监测患者也很重要，因为停药的病例中高达80%会在5年内复发。
