Üçok Alp
İstanbul School of Medicine, Department of Psychiatry, Psychotic Disorders Research Program, İstanbul, Turkey.
Noro Psikiyatr Ars. 2021 Sep 20;58(Suppl 1):S12-S16. doi: 10.29399/npa.27424. eCollection 2021.
Treatment of first-episode psychosis, which has unique advantages and challenges, has an impact on the course of the illness. On one hand, clinician has to understand triggering factors of psychosis and make differential diagnosis, and on other hand he has to choose a rationale psychopharmacological treatment. Although there is no difference between first generation antipsychotics and second generation antipsychotics in terms of effectiveness, the latter group has advantages in terms of side effects and tolerability. Tolerability issues and particularly metabolic side effects should be taken into account when choosing antipsychotic to treat first episode and beyond. Additionally, psychosocial approaches like family psychoeducation should be combined with pharmacological approaches in early phase of psychosis. Clinicians should monitor the medication adherence in every outpatient visit, and minimum duration of treatment is recommended as three years after remission.
首发精神病的治疗具有独特的优势和挑战，会对疾病进程产生影响。一方面，临床医生必须了解精神病的触发因素并进行鉴别诊断，另一方面，他必须选择合理的精神药物治疗。尽管第一代抗精神病药物和第二代抗精神病药物在疗效方面没有差异，但后者在副作用和耐受性方面具有优势。在选择抗精神病药物治疗首发及后续阶段时，应考虑耐受性问题，尤其是代谢副作用。此外，在精神病早期，应将家庭心理教育等社会心理方法与药物治疗方法相结合。临床医生应在每次门诊就诊时监测药物依从性，建议缓解后最短治疗持续时间为三年。
