Emsley Robin, Kilian Sanja, Phahladira Lebogang
Department of Psychiatry, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg Campus, Cape Town, South Africa.
Curr Opin Psychiatry. 2016 May;29(3):224-9. doi: 10.1097/YCO.0000000000000249.
In this article, recent publications addressing the pros and cons of antipsychotic maintenance treatment are reviewed and some recommendations formulated.
On one hand, relapse rates are extremely high when antipsychotic treatment is discontinued, even after a single episode of psychosis; there are no reliable predictors of relapse; and there are serious psychosocial and biological consequences of relapse. On the other hand, in addition to the well recognised side-effect burden of antipsychotics, a few recent publications suggest an association between greater exposure to antipsychotic treatment and poorer long-term outcome.
There is more evidence in favour of maintaining patients on antipsychotics than on stopping them. There is an urgent need for more and better research before the question of duration of maintenance after a single episode of schizophrenia can be answered with confidence. Until such studies have been conducted, clinicians should prioritize relapse prevention, particularly in the early years of illness, by encouraging indefinite, continuous antipsychotic treatment, and avoid unnecessary side-effects by using the lowest possible effective dose and selecting the best tolerated antipsychotic.
本文回顾了近期关于抗精神病药物维持治疗利弊的相关出版物，并提出了一些建议。
一方面，即使仅经历过一次精神病发作，停用抗精神病药物治疗后复发率极高；目前尚无可靠的复发预测指标；而且复发会带来严重的心理社会和生物学后果。另一方面，除了抗精神病药物众所周知的副作用负担外，最近的一些出版物表明，接受更多抗精神病药物治疗与较差的长期预后之间存在关联。
有更多证据支持让患者持续使用抗精神病药物而非停药。在能够自信地回答单次发作精神分裂症后的维持治疗时长问题之前，迫切需要开展更多更好的研究。在进行此类研究之前，临床医生应优先预防复发，尤其是在疾病早期，鼓励进行无限期、持续的抗精神病药物治疗，并通过使用尽可能低的有效剂量和选择耐受性最佳的抗精神病药物来避免不必要的副作用。
