Riedmüller Rita, Müller Sabine
Mind and Brain Research, Department of Psychiatry and Psychotherapy, CCM, Charité - Universitätsmedizin Berlin , Berlin , Germany.
Front Psychiatry. 2017 Mar 13;8:38. doi: 10.3389/fpsyt.2017.00038. eCollection 2017.
Schizophrenia is a serious mental disease with a high mortality rate and severe social consequences. Due to insufficient knowledge about its etiopathogenesis, curative treatments are not available. One of the most promising new research concepts is the mild encephalitis hypothesis of schizophrenia, developed mainly by Karl Bechter and Norbert Müller. According to this hypothesis, a significant subgroup of schizophrenia patients suffer from a mild, but chronic, form of encephalitis with markedly different etiologies ranging from viral infections, traumas to autoimmune diseases. This inflammatory process is thought to occur in the beginning or during the course of the disease. In this article, we investigate the consequences of the mild encephalitis hypothesis of schizophrenia for the scientific community, and evaluate these consequences ethically. The mild encephalitis hypothesis implies that schizophrenia would no longer be considered an incurable psychiatric disorder. Instead, it would be considered a chronic, but treatable, neurological disease. This paradigm shift would doubtlessly have significant consequences: (1) major reforms would be necessary in the theoretical conceptualization of schizophrenia, which would challenge the psychiatric diagnostic systems, Diagnostic and Statistical Manual of Mental Disorders version 5 and ICD-10. (2) Psychotic patients should be treated in interdisciplinary teams, optimally in neuropsychiatric units; additionally, specialists for endocrinology, diabetology, and cardiology should be consulted for the frequently occuring somatic comorbidities. (3) Current diagnostic procedures and (4) therapies would have to be modified significantly. (5) There might be repercussions for the pharmaceutical industry as well: first, because old drugs with expired patent protection could partly replace expensive drugs and, second, because there would be a demand for the development of new anti-inflammatory drugs. (6) Legal evaluation of compulsory treatment orders might have to be reconsidered in light of causal therapies; leading to increased legal approval and reduced need for compulsory treatment orders due to better patient compliance. (7) The social inclusion of patients might improve, if treatment became more effective regarding cognitive and social functioning. (8) The stigmatization of patients and their relatives might decrease.
精神分裂症是一种严重的精神疾病,死亡率高且会造成严重的社会后果。由于对其病因发病机制的了解不足,目前尚无治愈性治疗方法。最有前景的新研究概念之一是精神分裂症的轻度脑炎假说,主要由卡尔·贝希特和诺伯特·米勒提出。根据这一假说,相当一部分精神分裂症患者患有轻度但慢性的脑炎,其病因明显不同,包括病毒感染、创伤和自身免疫性疾病。这种炎症过程被认为发生在疾病的初期或病程中。在本文中,我们研究了精神分裂症轻度脑炎假说对科学界的影响,并从伦理角度对这些影响进行了评估。轻度脑炎假说意味着精神分裂症将不再被视为一种无法治愈的精神障碍。相反,它将被视为一种慢性但可治疗的神经疾病。这种范式转变无疑会产生重大影响:(1)精神分裂症的理论概念化需要进行重大改革,这将挑战精神疾病诊断系统《精神疾病诊断与统计手册》第5版和ICD - 10。(2)精神病患者应由跨学科团队治疗,最好是在神经精神科病房;此外,对于频繁出现的躯体合并症,应咨询内分泌科、糖尿病科和心脏病科专家。(3)当前的诊断程序和(4)治疗方法必须进行重大修改。(5)这可能也会对制药行业产生影响:首先,因为专利保护过期的旧药可能会部分取代昂贵的药物;其次,因为会有开发新抗炎药物的需求。(6)鉴于因果疗法,可能需要重新考虑强制治疗令的法律评估;由于患者依从性提高,导致强制治疗令的法律批准增加,需求减少。(7)如果治疗在认知和社会功能方面变得更有效,患者的社会融入可能会改善。(8)患者及其亲属的污名化可能会减少。
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