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抗精神病药物的意义与管理:一项针对精神分裂症诊断患者的研究。

The meaning and management of neuroleptic medication: a study of patients with a diagnosis of schizophrenia.

作者信息

Rogers A, Day J C, Williams B, Randall F, Wood P, Healy D, Bentall R P

机构信息

National Primary Care Research and Development Centre, University of Manchester, UK.

出版信息

Soc Sci Med. 1998 Nov;47(9):1313-23. doi: 10.1016/s0277-9536(98)00209-3.

Abstract

The meaning of medication and the way in which people use medicines has been the focus of a number of studies in recent years. However, there has been little attention directed to the meaning and management of neuroleptic medication by people who have received a diagnosis of schizophrenia. This topic is highly relevant to policy because of the central role given to neuroleptics in contemporary mental health and community care services. Using data from in-depth interviews with people with a diagnosis of schizophrenia we explore patients reasons for taking neuroleptics and the ways in which patients self-regulate their medication. The data suggest that the main utility of taking neuroleptic medication is to control specific symptoms and to gain personal control over managing symptoms. The costs of taking medication were side-effects which at times equalised or outweighed the positive gains of the neuroleptic medication. Patient accounts suggest that everyday medication practices are to a significant degree related to a policy context which stresses the need to survey and control the behaviour of people living in the community and the wider meaning and symbolic significance that schizophrenia has for patients in their everyday lives. For this reason, self regulatory action in this group of patients tends to be less evident and the threat of external social control greater than patients taking medication for other chronic conditions. The findings suggest the need to develop a collaborative patient-centred model of medication management for patients diagnosed with schizophrenia.

摘要

药物的意义以及人们使用药物的方式一直是近年来多项研究的重点。然而,对于被诊断患有精神分裂症的人而言,抗精神病药物的意义和管理却很少受到关注。由于抗精神病药物在当代心理健康和社区护理服务中占据核心地位,这一话题与政策高度相关。我们利用对被诊断患有精神分裂症的人进行深入访谈所获得的数据,探讨患者服用抗精神病药物的原因以及患者自我管理用药的方式。数据表明,服用抗精神病药物的主要效用是控制特定症状并获得对症状管理的个人掌控。服药的代价是副作用,这些副作用有时抵消或超过了抗精神病药物的积极疗效。患者的叙述表明,日常用药行为在很大程度上与一种政策背景相关,这种政策背景强调需要对社区居民的行为进行调查和控制,以及精神分裂症在患者日常生活中所具有的更广泛意义和象征意义。因此,相较于因其他慢性病而服药的患者,这组患者的自我管理行为往往不太明显,外部社会控制的威胁则更大。研究结果表明,有必要为被诊断患有精神分裂症的患者建立一种以患者为中心的协作式药物管理模式。

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