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影响精神分裂症综合治疗方法疗效的因素:文献综述

Factors influencing the outcome of integrated therapy approach in schizophrenia: A narrative review of the literature.

作者信息

Giordano Giulia M, Brando Francesco, Pezzella Pasquale, De Angelis Maria, Mucci Armida, Galderisi Silvana

机构信息

University of Campania Luigi Vanvitelli, Naples, Italy.

出版信息

Front Psychiatry. 2022 Aug 30;13:970210. doi: 10.3389/fpsyt.2022.970210. eCollection 2022.

Abstract

The integration of pharmacotherapy with psychosocial interventions has an important role to play in the improvement of functional outcome of subjects with schizophrenia (SCZ), in all stages of the disorder. It is essential for the adequate management of unmet therapeutic needs, such as negative symptoms and cognitive dysfunctions which account for most of the functional impairment of subjects with SCZ and do not respond to available antipsychotics. Enhancing the knowledge on factors involved in the effectiveness of integrated treatment plans is an important step forward for SCZ care. This review aims to identify factors that might influence the impact of integrated treatments on functional outcome. Most studies on the impact of psychosocial treatments on functional outcome of subjects with SCZ did not control for the effect of prescribed antipsychotics or concomitant medications. However, several factors relevant to ongoing pharmacological treatment might influence the outcome of integrated therapy, with an impact on the adherence to treatment (e.g., therapeutic alliance and polypharmacotherapy) or on illness-related factors addressed by the psychosocial interventions (e.g., cognitive dysfunctions or motivational deficits). Indirect evidence suggests that treatment integration should consider the possible detrimental effects of different antipsychotics or concomitant medications on cognitive functions, as well as on secondary negative symptoms. Cognitive dysfunctions can interfere with participation to an integrated treatment plan and can be worsened by extrapyramidal or metabolic side effects of antipsychotics, or concomitant treatment with anticholinergics or benzodiazepines. Secondary negative symptoms, due to positive symptoms, sedation, extrapyramidal side effects or untreated depression, might cause early drop-out and poor adherence to treatment. Researchers and clinicians should examine all the above-mentioned factors and implement appropriate and personalized integrated treatments to improve the outcome of SCZ.

摘要

药物治疗与心理社会干预相结合,在改善精神分裂症(SCZ)患者疾病各阶段的功能结局方面发挥着重要作用。这对于充分满足未得到满足的治疗需求至关重要,比如阴性症状和认知功能障碍,这些因素导致了SCZ患者的大部分功能损害,且对现有抗精神病药物无反应。增进对综合治疗计划有效性相关因素的了解,是SCZ护理向前迈出的重要一步。本综述旨在确定可能影响综合治疗对功能结局影响的因素。大多数关于心理社会治疗对SCZ患者功能结局影响的研究,并未控制规定的抗精神病药物或伴随用药的效果。然而,一些与正在进行的药物治疗相关的因素,可能会影响综合治疗的结果,对治疗依从性(例如治疗联盟和多药联合治疗)或心理社会干预所涉及的疾病相关因素(例如认知功能障碍或动机缺陷)产生影响。间接证据表明,治疗整合应考虑不同抗精神病药物或伴随用药对认知功能以及继发性阴性症状可能产生的有害影响。认知功能障碍会干扰对综合治疗计划的参与,并且可能因抗精神病药物的锥体外系或代谢副作用,或与抗胆碱能药物或苯二氮䓬类药物的联合治疗而恶化。由于阳性症状、镇静作用、锥体外系副作用或未治疗的抑郁症导致的继发性阴性症状,可能会导致早期退出治疗和治疗依从性差。研究人员和临床医生应检查上述所有因素,并实施适当的个性化综合治疗,以改善SCZ的治疗效果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d0e/9476599/6c6b36fdb187/fpsyt-13-970210-g0001.jpg

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