Keller William R, Fischer Bernard A, McMahon Robert, Meyer Walter, Blake Melissa, Buchanan Robert W
*Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore; and †VA Capital Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, MD.
J Nerv Ment Dis. 2014 Jan;202(1):6-12. doi: 10.1097/NMD.0000000000000093.
The 2003 Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations and the Mount Sinai Conference Safety Monitoring recommendations generated guidelines for pharmacological treatment of schizophrenia and monitoring of antipsychotic side effects. This study examined rate of recommendation adherence and impact of adherence on outcomes of outpatients with schizophrenia or schizoaffective disorder in community mental health centers. Clinical practice was assessed as conformant, nonconformant, or not applicable. Treatment practices were conformant for antipsychotic dose (83%); use of antiparkinsonian (97%), antidepressant (100%), and antianxiety agents (90%) but not clozapine for residual positive symptoms (31%); and monitoring weight gain (48%), glucose dysregulation (53%), hyperlipidemia (34%), or extrapyramidal symptoms (11%). Community mental health center treatment practices were largely conformant with the 2003 Schizophrenia PORT treatment recommendations. There is less evidence that patients who receive treatment in the community are adequately monitored for antipsychotic side effects per the Mount Sinai recommendations.
2003年精神分裂症患者转归研究团队（PORT）的治疗建议以及西奈山会议安全监测建议产生了精神分裂症药物治疗及抗精神病药物副作用监测的指南。本研究调查了社区心理健康中心精神分裂症或分裂情感性障碍门诊患者的建议依从率以及依从性对其转归的影响。临床实践被评估为符合、不符合或不适用。治疗实践在抗精神病药物剂量方面符合率为83%；使用抗帕金森病药物的符合率为97%，使用抗抑郁药物的符合率为100%，使用抗焦虑药物的符合率为90%，但针对残留阳性症状使用氯氮平的符合率为31%；监测体重增加的符合率为48%，监测血糖失调的符合率为53%，监测高脂血症的符合率为34%，监测锥体外系症状的符合率为11%。社区心理健康中心的治疗实践在很大程度上符合2003年精神分裂症PORT治疗建议。但较少有证据表明，按照西奈山会议的建议，社区接受治疗的患者在抗精神病药物副作用方面得到了充分监测。
