Academic Division of Clinical Psychology, University of Manchester, UK.
Int J Psychiatry Clin Pract. 2000;4(1):35-51. doi: 10.1080/13651500050518028.
The multifactorial nature of schizophrenia and the wide-ranging impact of the illness on the patient, their family, carers and healthcare providers mean that clinicians must be prepared to take a holistic approach to treatment. It is widely recognized that a patient's beliefs about their treatment and their experiences of schizophrenia can be very important in determining both attitude towards treatment compliance and behaviour in response to symptoms of the illness and environmental stress. Antipsychotic therapy remains the cornerstone of treatment for schizophrenia. However, there is now growing evidence to support the benefits of non-pharmacological interventions, when used in combination with antipsychotic treatment, in relieving symptoms, improving occupational and social functioning and reducing the risk of relapse. In particular, these interventions appear to provide benefits in coping skills and social and vocational functioning, as reflected in a greater ability to function independently and an improvement in quality of life. Systematic assessment of non-pharmacological therapies in schizophrenia is still a relatively new science, but there is good evidence that psychosocial therapies, such as family intervention therapy, cognitive-behaviour therapy and compliance therapy can markedly change a patient's behaviour and improve adherence to treatment and hence interaction with families, carers and healthcare providers. Psychosocial interventions can be implemented from the first episode of psychosis onwards and can contribute to an improved overall outcome in schizophrenia, to patients being more satisfied with their treatment, and to a better quality of life for the patient and their family. Initial comprehensive assessment will involve regular contact with the patient and opens channels for an ongoing dialogue. It is important that these discussions with the patients and their families and carers not only cover the need for social, emotional and behavioural support but include regular discussion of the acceptability and side-effects of antipsychotic treatment so that problems can be identified and addressed promptly. While the importance of non-pharmacological interventions in improving the quality of patient care is becoming widely accepted, access to psychological, psycho-educational and family support is by no means universal in current clinical practice. It is important that these services, provided by appropriately trained personnel, are made available to all patients for whom they may be appropriate.
精神分裂症的多因素性质以及该疾病对患者、他们的家人、照顾者和医疗保健提供者的广泛影响，意味着临床医生必须准备采取整体治疗方法。人们普遍认识到，患者对治疗的信念以及他们对精神分裂症的体验，对于确定他们对治疗的态度以及对疾病症状和环境压力的反应行为，非常重要。抗精神病药物治疗仍然是精神分裂症治疗的基石。然而，现在越来越多的证据支持非药物干预的益处，当与抗精神病药物治疗联合使用时，这些干预措施可以缓解症状、改善职业和社会功能以及降低复发风险。特别是，这些干预措施似乎在应对技能和社会和职业功能方面提供了益处，这反映在更独立的功能能力和生活质量的提高上。精神分裂症中非药物治疗的系统评估仍然是一个相对较新的科学领域，但有充分的证据表明，心理社会治疗，如家庭干预治疗、认知行为治疗和依从性治疗，可以显著改变患者的行为，提高对治疗的依从性，从而改善与家庭、照顾者和医疗保健提供者的互动。心理社会干预可以从精神病首次发作开始实施，并可以促进精神分裂症的整体结果改善，使患者对治疗更满意，并提高患者及其家庭的生活质量。初步的全面评估将包括与患者的定期接触，并为持续对话开辟渠道。重要的是，与患者及其家人和照顾者的这些讨论不仅涵盖了社会、情感和行为支持的需求，还包括定期讨论抗精神病药物治疗的可接受性和副作用，以便及时发现和解决问题。虽然非药物干预在改善患者护理质量方面的重要性已被广泛接受，但在当前的临床实践中，并非所有患者都能获得心理、心理教育和家庭支持。重要的是，所有合适的患者都能获得由经过适当培训的人员提供的这些服务。
