Englisch Susanne, Zink Mathias
Senior Resident, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health (CIMH). Mannheim, Germany.
Mens Sana Monogr. 2012 Jan;10(1):20-32. doi: 10.4103/0973-1229.91588.
Treatment-resistant symptoms complicate the clinical course of schizophrenia, and a large proportion of patients do not reach functional recovery. In consequence, polypharmacy is frequently used in treatment-refractory cases, addressing psychotic positive, negative and cognitive symptoms, treatment-emergent side effects caused by antipsychotics and comorbid depressive or obsessive-compulsive symptoms. To a large extent, such strategies are not covered by pharmacological guidelines which strongly suggest antipsychotic monotherapy. Add-on strategies comprise combinations of several antipsychotic agents and augmentations with mood stabilizers; moreover, antidepressants and experimental substances are applied. Based on the accumulated evidence of clinical trials and meta-analyses, combinations of clozapine with certain second-generation antipsychotic agents and the augmentation of antipsychotics with antidepressants seem recommendable, while the augmentation with mood stabilizers cannot be considered superior to placebo. Forthcoming investigations will have to focus on innovative pharmacological agents, the clinical spectrum of cognitive deficits and the implementation of cognitive behavioral therapy.
难治性症状使精神分裂症的临床病程复杂化，且很大一部分患者无法实现功能康复。因此，联合用药在难治性病例中经常使用，用于解决精神病性阳性、阴性和认知症状、抗精神病药物引起的治疗中出现的副作用以及共病的抑郁或强迫症状。在很大程度上，此类策略未被强烈建议采用抗精神病药物单一疗法的药理学指南所涵盖。联合用药策略包括几种抗精神病药物的联合使用以及用心境稳定剂进行增效治疗；此外，还应用了抗抑郁药和实验性药物。基于临床试验和荟萃分析积累的证据，氯氮平与某些第二代抗精神病药物联合使用以及用抗抑郁药增强抗精神病药物疗效似乎是可取的，而用心境稳定剂增效治疗并不优于安慰剂。未来的研究将不得不聚焦于创新的药理学药物、认知缺陷的临床范围以及认知行为疗法的实施。
