Skolnick M R
Yale J Biol Med. 1985 Jul-Aug;58(4):317-26.
Theoretical and practical issues involved in integrating pharmacotherapy and psychosocial therapy in a long-term day hospital for schizophrenics are addressed. The limitations and risks of relying too heavily on a biomedical conceptual framework are discussed. In addition to diagnosis, target symptoms, pharmacodynamics, and pharmacokinetics, individual interpersonal, family, and institutional dynamics can exert profound effects on the effectiveness of medication. Through case illustrations it is shown how an open systems model and a group approach can allow for an integration of the many variables involved in the medication process. A weekly medication group which emphasizes education, informed choice, patient responsibility, and the examination of the boundary between medication effect and the need for psychological work is described. It is shown that the chemical control of psychosis alone may reinforce the psychosocial aspects of the schizophrenic syndrome. A distinction is drawn between chemical control of psychosis and the sensitive use of medication as a facilitator of growth-promoting psychosocial treatment.
本文探讨了在长期日间医院对精神分裂症患者整合药物治疗和心理社会治疗所涉及的理论和实际问题。讨论了过度依赖生物医学概念框架的局限性和风险。除了诊断、目标症状、药效学和药代动力学外，个体的人际、家庭和机构动态也会对药物疗效产生深远影响。通过案例说明，展示了开放系统模型和团体方法如何能够整合药物治疗过程中涉及的诸多变量。描述了一个每周一次的药物治疗团体，该团体强调教育、明智选择、患者责任以及对药物效果与心理治疗需求之间界限的审视。研究表明，仅对精神病进行化学控制可能会强化精神分裂症综合征的心理社会方面。文中区分了对精神病的化学控制与将药物敏感地用作促进成长的心理社会治疗的辅助手段。
