Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, New York, USA; Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
J Clin Psychiatry. 2020 Apr 14;81(3):MS19053BR2C. doi: 10.4088/JCP.MS19053BR2C.
Syndromal recovery, satisfactory quality of life, and adequate functionality are relevant goals that define successful treatment of schizophrenia. Recovery requires effective symptom control in multiple clinical domains but also sufficient self-care and social and educational/vocational functionality. The finding that residual negative and cognitive symptoms have been related strongly to inadequate levels of functioning in people with schizophrenia is related to the fact that current pharmacologic agents tend to be most effective for the positive symptoms of the disease. Additional challenges include psychiatric comorbidities and adverse events related to medication that can lead to secondary negative and cognitive symptoms and nonadherence, all of which can worsen outcomes. Treatment modalities that target cognition and functional rehabilitation without introducing tolerability issues are needed. In general, pharmacologic interventions should be combined with evidence-based nonpharmacologic treatments, and patient-reported outcomes as well as measurement-based care should be employed, ideally in a coordinated specialty care framework. To facilitate positive treatment decisions, a combined shared decision and motivational interviewing approach should be implemented.
综合征缓解、生活质量满意和功能充足是定义精神分裂症成功治疗的相关目标。恢复需要在多个临床领域有效控制症状，但也需要足够的自我护理以及社会和教育/职业功能。残留的阴性和认知症状与精神分裂症患者功能不足程度密切相关的发现与以下事实有关，即目前的药物治疗对疾病的阳性症状最为有效。其他挑战包括精神共病和与药物相关的不良事件，这可能导致继发性阴性和认知症状以及不遵医嘱，所有这些都会使结果恶化。需要针对认知和功能康复的治疗方式，而不会带来耐受性问题。一般来说，药物干预应与基于证据的非药物治疗相结合，应采用患者报告的结果和基于测量的护理，理想情况下在协调的专科护理框架中进行。为了促进积极的治疗决策，应实施联合的共享决策和动机性访谈方法。
