Kirchner Sophie K, Roeh Astrid, Nolden Jana, Hasan Alkomiet
Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.
NPJ Schizophr. 2018 Oct 3;4(1):20. doi: 10.1038/s41537-018-0062-8.
The main objective of this review was to evaluate studies on the diagnosis, treatment, and course of schizotypal personality disorder and to provide a clinical guidance on the basis of that evaluation. A systematic search in the PubMed/MEDLINE databases was conducted. Two independent reviewers extracted and assessed the quality of the data. A total of 54 studies were eligible for inclusion: 18 were on diagnostic instruments; 22, on pharmacological treatment; 3, on psychotherapy; and 13, on the longitudinal course of the disease. We identified several suitable and reliable questionnaires for screening (PDQ-4+ and SPQ) and diagnosing (SIDP, SIDP-R, and SCID-II) schizotypal personality disorder. Second-generation antipsychotics (mainly risperidone) were the most often studied drug class and were described as beneficial. Studies on the longitudinal course described a moderate remission rate and possible conversion rates to other schizophrenia spectrum disorders. Because of the heterogeneity of the studies and the small sample sizes, it is not yet possible to make evidence-based recommendations for treatment. This is a systematic evaluation of diagnostic instruments and treatment studies in schizotypal personality disorder. We conclude that there is currently only limited evidence on which to base treatment decisions in this disorder. Larger interventional trials are needed to provide the data for evidence-based recommendations.
本综述的主要目的是评估有关分裂型人格障碍的诊断、治疗及病程的研究,并在此评估基础上提供临床指导。我们在PubMed/MEDLINE数据库中进行了系统检索。两名独立评审员提取并评估了数据质量。共有54项研究符合纳入标准:18项涉及诊断工具;22项涉及药物治疗;3项涉及心理治疗;13项涉及疾病的纵向病程。我们确定了几种适用于筛查(人格障碍问卷-4+和分裂型人格问卷)和诊断(精神分裂症型人格障碍诊断量表、修订版精神分裂症型人格障碍诊断量表和精神障碍诊断与统计手册第二版)分裂型人格障碍的合适且可靠的问卷。第二代抗精神病药物(主要是利培酮)是研究最多的药物类别,且被描述为有益。关于纵向病程的研究描述了中度缓解率以及向其他精神分裂症谱系障碍的可能转化率。由于研究的异质性和样本量较小,目前还无法做出基于证据的治疗建议。这是对分裂型人格障碍诊断工具和治疗研究的系统评价。我们得出结论,目前在这种疾病中用于治疗决策的依据证据有限。需要进行更大规模的干预试验以提供基于证据的建议所需的数据。