Guinart Daniel, Fagiolini Andrea, Fusar-Poli Paolo, Giordano Giulia Maria, Leucht Stefan, Moreno Carmen, Correll Christoph U
Institut de Salut Mental, Parc de Salut Mar, Barcelona, Spain.
Hospital Del Mar Research Institute, CIBERSAM, Barcelona, Spain.
Neuropsychiatr Dis Treat. 2024 May 24;20:1139-1152. doi: 10.2147/NDT.S456163. eCollection 2024.
Schizophrenia is a severe mental illness that usually begins in late adolescence or early adulthood. Current pharmacological treatments, while acceptably effective for many patients, are rarely clinically tailored or individualized. The lack of sufficient etiopathological knowledge of the disease, together with overall comparable effect sizes for efficacy between available antipsychotics and the absence of clinically actionable biomarkers, has hindered the advance of individualized medicine in the treatment of schizophrenia. Nevertheless, some degree of stratification based on clinical markers could guide treatment choices and help clinicians move toward individualized psychiatry. To this end, a panel of experts met to formally discuss the current approach to individualized treatment in schizophrenia and to define how treatment individualization could help improve clinical outcomes.
A task force of seven experts iteratively developed, evaluated, and refined questionnaire items, which were then evaluated using the Delphi method. Descriptive statistics were used to summarize and rank expert responses. Expert discussion, informed by the results of a scoping review on personalizing the pharmacologic treatment of adults and adolescents with schizophrenia, ultimately generated recommendations to guide individualized pharmacologic treatment in this population.
There was substantial agreement among the expert group members, resulting in the following recommendations: 1) individualization of treatment requires consideration of the patient's diagnosis, clinical presentation, comorbidities, previous treatment response, drug tolerability, adherence patterns, and social factors; 2) patient preferences should be considered in a shared decision-making approach; 3) identified barriers to personalized care that need to be overcome include the lack of actionable biomarkers and mechanistic similarities between available treatments, but digital tools should be increasingly used to enhance individualized treatment.
Individualized care can help provide effective, tailored treatments based on an individual's clinical characteristics, disease trajectory, family and social environment, and goals and preferences.
精神分裂症是一种严重的精神疾病，通常始于青春期晚期或成年早期。目前的药物治疗虽然对许多患者有可接受的疗效，但在临床上很少进行针对性调整或个体化治疗。对该疾病病因病理知识的不足，加上现有抗精神病药物之间疗效的总体效应大小相当，以及缺乏临床可操作的生物标志物，阻碍了精神分裂症个体化治疗的进展。然而，基于临床标志物的某种程度的分层可以指导治疗选择，并帮助临床医生走向个体化精神病学。为此，一组专家会面，正式讨论精神分裂症个体化治疗的当前方法，并确定治疗个体化如何有助于改善临床结果。
一个由七名专家组成的特别工作组反复制定、评估和完善问卷项目，然后使用德尔菲法进行评估。描述性统计用于总结专家回答并进行排名。在对精神分裂症成人和青少年药物治疗个体化的范围综述结果的指导下，专家讨论最终产生了指导该人群个体化药物治疗的建议。
专家组成员之间达成了实质性共识，得出以下建议：1）治疗个体化需要考虑患者的诊断、临床表现、合并症、既往治疗反应、药物耐受性、依从模式和社会因素；2）应在共同决策方法中考虑患者偏好；3）确定的需要克服的个性化护理障碍包括缺乏可操作的生物标志物以及现有治疗之间的机制相似性，但应越来越多地使用数字工具来加强个体化治疗。
个体化护理有助于根据个体的临床特征、疾病轨迹、家庭和社会环境以及目标和偏好提供有效、量身定制的治疗。
