Grawe R W, Falloon I R H, Widen J H, Skogvoll E
SINTEF Health Research, Trondheim, Norway.
Acta Psychiatr Scand. 2006 Nov;114(5):328-36. doi: 10.1111/j.1600-0447.2006.00799.x.
This random-controlled study evaluated benefits derived from continued integrated biomedical and psychosocial treatment for recent-onset schizophrenia.
Fifty cases of schizophrenia of less than 2 years duration were allocated randomly to integrated or standard treatment (ST) for 2 years. ST comprised optimal pharmacotherapy and case management, while IT also included cognitive-behavioural family treatment, that incorporated skills training, cognitive-behavioural strategies for residual psychotic and non-psychotic problems and home-based crisis management. Psychopathology, functioning, hospitalisation and suicidal behaviours were assessed two monthly and a composite index, reflecting overall clinical outcome was derived.
IC proved superior to ST in reducing negative symptoms, minor psychotic episodes and in stabilising positive symptoms, but did not reduce hospital admissions or major psychotic recurrences. The composite index showed that significantly more IC patients (53%) had excellent 2-year outcomes than ST (25%).
Evidence-based treatment achieves greater clinical benefits than pharmacotherapy and case management alone for recent-onset schizophrenia.
本随机对照研究评估了对近期发病的精神分裂症持续进行生物医学与心理社会综合治疗所带来的益处。
将50例病程少于2年的精神分裂症患者随机分配至综合治疗组或标准治疗组，为期2年。标准治疗包括最佳药物治疗和病例管理，而综合治疗还包括认知行为家庭治疗，其中纳入了技能训练、针对残留精神病性和非精神病性问题的认知行为策略以及居家危机管理。每两个月评估一次精神病理学、功能、住院情况和自杀行为，并得出一个反映总体临床结果的综合指数。
综合治疗在减轻阴性症状、轻微精神病性发作以及稳定阳性症状方面被证明优于标准治疗，但并未减少住院次数或严重精神病复发。综合指数显示，综合治疗组中有显著更多的患者（53%）在2年时获得了优异的结果，而标准治疗组为25%。
对于近期发病的精神分裂症，循证治疗比单纯的药物治疗和病例管理能带来更大的临床益处。
