Silverstein Steven M, Bellack Alan S
University Behavioral HealthCare and Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, United States.
Clin Psychol Rev. 2008 Oct;28(7):1108-24. doi: 10.1016/j.cpr.2008.03.004. Epub 2008 Mar 18.
Recovery is now a widely discussed concept in the field of research, treatment, and public policy regarding schizophrenia. As it has increasingly become a focus in mainstream psychiatry, however, it has also become clear both that the concept is often used in multiple ways, and that it lacks a strong scientific basis. In this review, we argue that such a scientific basis is necessary for the concept of recovery to have a significant long-term impact on the way that schizophrenia is understood and treated. The discussion focuses on key issues necessary to establish this scientific agenda, including: 1) differences in definitions of recovery and their implications for studying recovery processes and outcomes; 2) key research questions; 3) the implications of data from outcome studies for understanding what is possible for people diagnosed with schizophrenia; 4) factors that facilitate recovery processes and outcomes, and methods for studying these issues; and 5) recovery-oriented treatment, including issues raised by peer support. Additional conceptual issues that have not received sufficient attention in the literature are then noted, including the role of evidence-based practices in recovery-oriented care, recovery-oriented care for elderly people with schizophrenia, trauma treatment and trauma-informed care, and the role of hospitals in recovery-oriented treatment. Consideration of these issues may help to organize approaches to the study of recovery, and in doing so, improve the impact of recovery-based initiatives.
如今,在精神分裂症的研究、治疗及公共政策领域,康复是一个被广泛讨论的概念。然而,随着它日益成为主流精神病学的焦点,人们也越发清楚地认识到,这个概念的使用方式往往多种多样,且缺乏坚实的科学基础。在本综述中,我们认为,康复概念要对精神分裂症的理解和治疗方式产生重大的长期影响,这样的科学基础是必要的。讨论聚焦于确立这一科学议程所需的关键问题,包括:1)康复定义的差异及其对研究康复过程和结果的影响;2)关键研究问题;3)结果研究数据对理解精神分裂症患者可能实现的情况的启示;4)促进康复过程和结果的因素以及研究这些问题的方法;5)以康复为导向的治疗,包括同伴支持引发的问题。随后指出了文献中未得到充分关注的其他概念性问题,包括循证实践在以康复为导向的护理中的作用、针对老年精神分裂症患者的以康复为导向的护理、创伤治疗和创伤知情护理,以及医院在以康复为导向的治疗中的作用。对这些问题的思考可能有助于梳理康复研究的方法,并借此提高基于康复的举措的影响力。