Lieberman Jeffrey A, Drake Robert E, Sederer Lloyd I, Belger Aysenil, Keefe Richard, Perkins Diana, Stroup Scott
Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Psychiatr Serv. 2008 May;59(5):487-96. doi: 10.1176/ps.2008.59.5.487.
Mental health advocates and policy makers are increasingly attuned to the importance of the recovery concept, and psychiatrists and neuroscientists increasingly emphasize the medical model and neurobiological mechanisms in relation to schizophrenia. Studies have shown that people with schizophrenia are tremendously heterogeneous in each domain of recovery, and the various domains of recovery are themselves relatively independent from one another. Studies have also shown that current interventions are effective for specific dimensions of the illness and functions, are usually ameliorative rather than curative, and are effective only for a proportion of patients. Hence, the authors suggest defining recovery in terms of improvements in specific domains rather than globally -- for example, "recovery of cognitive functioning" or "recovery of vocational functioning" -- to signify improvements in specific areas. This definition realistically emphasizes states of relative and partial recovery that patients can achieve in response to treatment. The emphasis on a range of improvements in specific areas should allow clinicians to communicate more clearly regarding the current findings and goals of treatment. The article also examines current research on various aspects of recovery, including the effects of treatment on pathophysiology, symptoms, cognitive impairments, quality of life, and self-agency. An operational definition of recovery allows for bridging hope and recovery with important advances in the science of the brain. Future clinical and neuroscience research and service development should emphasize measures of recovery as outcomes for people with schizophrenia.
心理健康倡导者和政策制定者越来越意识到康复概念的重要性,而精神科医生和神经科学家越来越强调与精神分裂症相关的医学模式和神经生物学机制。研究表明,精神分裂症患者在康复的各个领域都存在极大的异质性,而且康复的各个领域本身相对彼此独立。研究还表明,当前的干预措施对疾病和功能的特定维度有效,通常是改善而非治愈,并且仅对一部分患者有效。因此,作者建议从特定领域而非整体的改善方面来定义康复——例如,“认知功能的康复”或“职业功能的康复”——以表明特定领域的改善。这个定义切实强调了患者在接受治疗后能够实现的相对和部分康复状态。强调特定领域的一系列改善应该能让临床医生就当前的研究结果和治疗目标进行更清晰的沟通。本文还探讨了当前关于康复各个方面的研究,包括治疗对病理生理学、症状、认知障碍、生活质量和自我能动性的影响。康复的操作性定义有助于将希望和康复与大脑科学的重要进展联系起来。未来的临床和神经科学研究以及服务发展应该强调将康复措施作为精神分裂症患者的治疗结果。
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