精神分裂症全病程治疗(梅其一).ppt

维持治疗对复发的影响 维持期不持续治疗的精分患者1年内复发率为60-70%，2年内复发率高达90% 维持期抗精神治疗有效预防首次发作后缓解患者的复发：1年内复发率为0-46% 持续治疗对复发率的影响 Kane JM. N Engl J Med 1996;334:34–41 典型抗精神病药物1年持续治疗和间断治疗的复发率比较 0 10 20 30 40 50 60 复发率(%) Schooler et al., 1993 Pietzcker et al., 1993 Jolley et al., 1989, 1990 Herz et al., 1991 Carpenter et al., 1990 持续治疗 间断治疗 20 32 15 35 7 30 10 29 33 55 间断服药的复发风险越是持续服药的2倍 精神分裂症的治疗目标 进一步消除症状 防止复发 恢复社会功能 回归社会 帮助患者及家属 应对社会或躯体应激 减少不良反应 预防自杀 尽快消除症状 控制危害 减少不良反应 为恢复社会功能、回归社会做准备 急性期治疗 恢复期治疗 维持期治疗 《中国精神分裂症防治指南》 用药依从性差可导致治疗失败 月复发率（%） 与持续用药相比，无法持续应用抗精神病药的 精神分裂症患者复发率更高 Peter J. Weiden and Mark Olfson Schizophrenia Bulletin.1995;21(3):419-429. CATIE研究：不同非典型药物的中断率 Lieberman, J. A. et al. (2005). N Engl J Med, 353(12), 1209-1223. 奥氮平 喹硫平 利培酮 奋乃静 齐哌西酮 总结 精神分裂症是一种神经发育性疾病，全病程治疗十分重要。 精神分裂症治疗目标为康复，既症状缓解，不复发和最低水平的功能恢复 整合治疗（lntegrated care）为精神病患者提供全面支持，帮助患者回归正常生活 选择急性期治疗快速控制症状，长期治疗依从性好、中断率低的抗精神病药 * * Neurodevelopmental model of schizophrenia. a, Normal cortical development involves proliferation, migration, arborization (circuit formation) and myelination, with the first two processes occurring mostly during prenatal life and the latter two continuing through the first two post-natal decades. The combined effects of pruning of the neuronal arbor and myelin deposition are thought to account for the progressive reduction of grey-matter volume observed with longitudinal neuroimaging. Beneath this observed overall reduction, local changes are far more complex. Data from human and nonhuman primate brain indicate increases in inhibitory and decreases in excitatory synaptic strength occurring in prefrontal cortex throughout * The trajectory in children developing schizophrenia could include reduced elaboration of inhibitory pathways and excessive pruning of excitatory pathways leading to altered excitatory–inhibitory balance in the prefrontal cortex. Reduced myelination would alter connectivity. * R. Tandon et al. / Schizophrenia Research 110 (2009) 1–23 患病前期-- * * 多次复发不仅增加再入院率，复发