Correll Christoph U, Martin Amber, Patel Charmi, Benson Carmela, Goulding Rebecca, Kern-Sliwa Jennifer, Joshi Kruti, Schiller Emma, Kim Edward
The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA.
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA.
Schizophrenia (Heidelb). 2022 Feb 24;8(1):5. doi: 10.1038/s41537-021-00192-x.
Clinical practice guidelines (CPGs) translate evidence into recommendations to improve patient care and outcomes. To provide an overview of schizophrenia CPGs, we conducted a systematic literature review of English-language CPGs and synthesized current recommendations for the acute and maintenance management with antipsychotics. Searches for schizophrenia CPGs were conducted in MEDLINE/Embase from 1/1/2004-12/19/2019 and in guideline websites until 06/01/2020. Of 19 CPGs, 17 (89.5%) commented on first-episode schizophrenia (FES), with all recommending antipsychotic monotherapy, but without agreement on preferred antipsychotic. Of 18 CPGs commenting on maintenance therapy, 10 (55.6%) made no recommendations on the appropriate maximum duration of maintenance therapy, noting instead individualization of care. Eighteen (94.7%) CPGs commented on long-acting injectable antipsychotics (LAIs), mainly in cases of nonadherence (77.8%), maintenance care (72.2%), or patient preference (66.7%), with 5 (27.8%) CPGs recommending LAIs for FES. For treatment-resistant schizophrenia, 15/15 CPGs recommended clozapine. Only 7/19 (38.8%) CPGs included a treatment algorithm.
临床实践指南（CPGs）将证据转化为建议，以改善患者护理和治疗效果。为了概述精神分裂症临床实践指南，我们对英文临床实践指南进行了系统的文献综述，并综合了当前关于抗精神病药物急性和维持治疗的建议。在2004年1月1日至2019年12月19日期间，我们在MEDLINE/Embase数据库中检索了精神分裂症临床实践指南，并在指南网站上检索至2020年6月1日。在19份临床实践指南中，17份（89.5%）对首发精神分裂症（FES）发表了评论，均推荐抗精神病药物单一疗法，但对于首选抗精神病药物未达成一致。在18份对维持治疗发表评论的临床实践指南中，10份（55.6%）未就维持治疗的合适最长疗程提出建议，而是指出应个体化治疗。18份（94.7%）临床实践指南对长效注射用抗精神病药物（LAIs）发表了评论，主要涉及不依从情况（77.8%）、维持治疗（72.2%）或患者偏好（66.7%），5份（27.8%）临床实践指南推荐将长效注射用抗精神病药物用于首发精神分裂症。对于难治性精神分裂症，15/15份临床实践指南推荐使用氯氮平。只有7/19（38.8%）份临床实践指南包含治疗算法。
