精神分裂症的康复与预防复发.pptVIP

*多次复发不仅增加再入院率，复发期间达到痊愈的天数也明显延长，首次复发患者达到痊愈的天数为47天，而第三次复发的患者达到痊愈的天数则需要130天。多次复发导致病程迁延、增加治疗困难、疗效下降、存在残余症状、大幅增加了患者的医疗费用。*1.DoeringSetal.Predictorsofrelapseandrehospitalizationinschizophreniaandschizoaffectivedisorder.SchizophreniaBull1998;24:87-982.JClinPsychiatry.2003;64Suppl16:24-33.Choiceofmaintenancemedicationforschizophrenia.DavisJM,ChenN.**Relapseratesinclinicalpracticeareanestimatedthreetimeshigherthantheyneedtobe(Kissling,1994).Oneexplanationforhighrelapseratesinclinicalpracticeispooradherencetomedication(Robinsonetal.,1999).Thisproblemisnotuniquetoschizophrenia,butitisheightenedbypatients’poorjudgementandlackofinsightintotheirillnessandthebenefitsofmedication(Perkins,2002).Manypatientsrefusetheirmedicationorhavedifficultyadheringtocomplextreatmentregimens.Othersdonotrefillprescriptionsontimeifatall(Dolderetal.,2002).?Ameta-analysisbyCramerandRosenheck(1998)consideredallquantitativestudiesofcomplianceforantipsychoticsandantidepressantsfrom1975–1996.Theratesofcompliancewerecomparedfor10reportsonantidepressants,26onantipsychoticsand12onmedicationfornon-psychiatricdisorders.Antipsychoticshadthelowestmeancompliancerates,at58%.Antidepressantswerebetter,at65%.Theratefornon-psychiatricdisorderswas76%.Adherencetoantipsychoticsmaybelowerthan58%,asthecomplianceratesinthe26studiesrangedfrom24–90%.Theyweremeasuredmostlybypatientinterviews,clinicianjudgements,andurinetests.Theseareinaccuratemeasuresofnon-adherenceandarelikelytooverestimateadherencerates,becausetheyoverlookpartialcompliance,whendosesareoccasionallymissed(Crameretal.,1998).ReferencesCramerJ,RosenheckR.Compliancewithmedicationregimensformentalandphysicaldisorders.PsychiatrServ1998;49:196–201.DolderCR,LacroJP,DunnLB,JesteDV.Antipsy