Chien Wai Tong, Yip Annie Lk
School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
Neuropsychiatr Dis Treat. 2013;9:1311-32. doi: 10.2147/NDT.S37485. Epub 2013 Sep 11.
During the last three decades, an increasing understanding of the etiology, psychopathology, and clinical manifestations of schizophrenia spectrum disorders, in addition to the introduction of second-generation antipsychotics, has optimized the potential for recovery from the illness. Continued development of various models of psychosocial intervention promotes the goal of schizophrenia treatment from one of symptom control and social adaptation to an optimal restoration of functioning and/or recovery. However, it is still questionable whether these new treatment approaches can address the patients' needs for treatment and services and contribute to better patient outcomes. This article provides an overview of different treatment approaches currently used in schizophrenia spectrum disorders to address complex health problems and a wide range of abnormalities and impairments resulting from the illness. There are different treatment strategies and targets for patients at different stages of the illness, ranging from prophylactic antipsychotics and cognitive-behavioral therapy in the premorbid stage to various psychosocial interventions in addition to antipsychotics for relapse prevention and rehabilitation in the later stages of the illness. The use of antipsychotics alone as the main treatment modality may be limited not only in being unable to tackle the frequently occurring negative symptoms and cognitive impairments but also in producing a wide variety of adverse effects to the body or organ functioning. Because of varied pharmacokinetics and treatment responsiveness across agents, the medication regimen should be determined on an individual basis to ensure an optimal effect in its long-term use. This review also highlights that the recent practice guidelines and standards have recommended that a combination of treatment modalities be adopted to meet the complex health needs of people with schizophrenia spectrum disorders. In view of the heterogeneity of the risk factors and the illness progression of individual patients, the use of multifaceted illness management programs consisting of different combinations of physical, psychological, and social interventions might be efficient and effective in improving recovery.
在过去三十年中，除了第二代抗精神病药物的引入，人们对精神分裂症谱系障碍的病因、精神病理学和临床表现有了越来越深入的了解，这优化了从该疾病中康复的可能性。各种心理社会干预模式的不断发展推动了精神分裂症治疗目标从症状控制和社会适应之一向功能的最佳恢复和/或康复转变。然而，这些新的治疗方法是否能够满足患者的治疗和服务需求并有助于改善患者预后仍值得怀疑。本文概述了目前用于精神分裂症谱系障碍以解决复杂健康问题以及该疾病导致的广泛异常和损害的不同治疗方法。对于疾病不同阶段的患者有不同的治疗策略和目标，从病前阶段的预防性抗精神病药物和认知行为疗法到疾病后期除抗精神病药物外用于预防复发和康复的各种心理社会干预。仅将抗精神病药物作为主要治疗方式可能存在局限性，不仅无法解决频繁出现的阴性症状和认知障碍，还会对身体或器官功能产生多种不良反应。由于不同药物的药代动力学和治疗反应性各不相同，药物治疗方案应根据个体情况确定，以确保其长期使用的最佳效果。本综述还强调，最近的实践指南和标准建议采用多种治疗方式的组合来满足精神分裂症谱系障碍患者的复杂健康需求。鉴于个体患者危险因素和疾病进展的异质性，由身体、心理和社会干预的不同组合组成的多方面疾病管理计划可能在促进康复方面高效且有效。
