Buckley Peter E, Evans Denise
Department of Psychiatry, Medical College of Georgia, Augusta 30912, USA.
Postgrad Med. 2006 Sep;Spec No:5-19.
The pernicious course of schizophrenia has spurred efforts to identify and effectively treat this condition as early as possible. This assertive therapeutic stance is supported by epidemiologic data suggesting a substantial time lag between onset of illness and therapeutic intervention, and by neurobiologic data suggesting that brain changes present in first-episode psychosis are comparable to those in chronic schizophrenia. The proposal that atypical antipsychotic medications may prevent illness deterioration and/or be a restorative intervention is an appealing, but as yet unproven, hypothesis. Major challenges to maximizing treatment outcomes in first-episode schizophrenia include optimizing timing and effectiveness of pharmacologic interventions, service coordination, and access to care. We present data on the onset and presentation of first-episode schizophrenia and emerging findings about the neurobiology of first episodes, review nonpharmacologic and pharmacologic management, and summarize clinical research data on use of atypical antipsychotics in first-episode patients.
精神分裂症的恶性病程促使人们努力尽早识别并有效治疗这种疾病。这种坚定的治疗立场得到了流行病学数据的支持，该数据表明疾病发作与治疗干预之间存在相当长的时间间隔，同时也得到了神经生物学数据的支持，该数据表明首发精神病患者大脑的变化与慢性精神分裂症患者的变化相当。非典型抗精神病药物可能预防疾病恶化和/或作为一种恢复性干预措施的提议是一个有吸引力但尚未得到证实的假设。在首发精神分裂症中实现最佳治疗效果的主要挑战包括优化药物干预的时机和效果以及服务协调，还有获得医疗服务的机会。我们展示了首发精神分裂症的起病和临床表现的数据以及关于首发疾病神经生物学的新发现，回顾了非药物和药物治疗管理，并总结了关于首发患者使用非典型抗精神病药物的临床研究数据。
