Carpenter W T
Department of Psychiatry, University of Maryland School of Medicine, Baltimore 21228, USA.
J Clin Psychiatry. 1996;57 Suppl 9:10-8.
Developments over the past 20 years in maintenance treatment have substantially reduced problems with relapses, rehospitalization, and serious psychopathology and dysfunction for most patients with schizophrenia. Therapeutic gains can be accomplished with minimal dosing strategies, targeted drug therapy for medication-refusing patients, psychosocial interventions, and new drugs. Although minimal dose maintenance requires close clinical monitoring and effective collaboration, this strategy reduces side effects and negative symptoms and may thereby translate into greater medication compliance. Psychosocial therapeutics that include family intervention in conjunction with antipsychotic drug treatment reduce relapse rates, but further study is needed. Lithium, carbamazepine, benzodiazepines, beta-blockers, and antidepressant drugs along with electroconvulsive therapy and social skills training provide other relevant approaches in maintenance treatment. Before a maintenance role for new drugs such as clozapine and risperidone is clarified, controlled studies are needed. However, the advantages with motor side effects and secondary negative symptoms should enhance clinical course and medication compliance, and superior antipsychotic prophylaxis is hypothesized. Special issues in maintenance treatment include difficulty in predicting relapse, increased risk of adverse drug effects in elderly patients, and complication of the nonpsychotic aspects of schizophrenia by continued use of antipsychotic drugs. Optimal maintenance treatment incorporates early detection and outpatient management of symptom exacerbation, minimal dosing to increase compliance and reduce adverse effects, psychosocial intervention to reduce relapse rates and enhance functioning, and the integration of several therapeutic modalities and the provision of case managers and assertive community treatment teams.
在过去20年里，维持治疗方面的进展已大幅减少了大多数精神分裂症患者在复发、再次住院以及严重精神病理学和功能障碍方面的问题。通过最小剂量策略、针对拒服药物患者的靶向药物治疗、心理社会干预以及新药，可以实现治疗收益。尽管最小剂量维持治疗需要密切的临床监测和有效的协作，但该策略可减少副作用和阴性症状，从而可能提高药物依从性。包括家庭干预与抗精神病药物治疗相结合的心理社会疗法可降低复发率，但仍需进一步研究。锂盐、卡马西平、苯二氮䓬类药物、β受体阻滞剂、抗抑郁药物以及电休克治疗和社交技能训练为维持治疗提供了其他相关方法。在明确氯氮平、利培酮等新药的维持治疗作用之前，需要进行对照研究。然而，这些药物在运动副作用和继发性阴性症状方面的优势应能改善临床病程和药物依从性，并推测其具有更好的抗精神病预防作用。维持治疗中的特殊问题包括难以预测复发、老年患者药物不良反应风险增加以及持续使用抗精神病药物导致精神分裂症非精神病方面的并发症。最佳维持治疗包括症状加重的早期发现和门诊管理、最小剂量用药以提高依从性并减少不良反应、心理社会干预以降低复发率并改善功能，以及整合多种治疗方式并提供个案管理员和积极社区治疗团队。
