Improving the care of individuals with schizophrenia and substance use disorders: consensus recommendations.
Improving the care of individuals with schizophrenia and substance use disorders: consensus recommendations.
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改善精神分裂症和物质使用障碍患者的护理：共识建议。
DOI：
10.1097/00131746-200509000-00005
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发表时间：
2005
影响因子：
1.9
通讯作者：
Weiss,RogerD
中科院分区：
文献类型：
--
作者：
Ziedonis,DouglasM;Smelson,David;Rosenthal,RichardN;Batki,StevenL;Green,AlanI;Henry,RenataJ;Montoya,Ivan;Parks,Joseph;Weiss,RogerD
正如2003年总统新自由委员会关于精神健康的报告和药物滥用和精神健康服务管理局最近的出版物所强调的那样，国家的注意力继续集中在需要改善对患有精神疾病和药物使用障碍的个人的护理上。这些报告记录了对可转化为常规临床护理的最佳做法建议的需求。尽管正在努力综合这一领域的文献，但很少有有针对性的建议，其中包括专家意见和基于证据的发现，关于精神分裂症和成瘾等特定共生疾病的管理。为了回应对精神分裂症和成瘾治疗提出方便用户的建议的需要，组织了一次学术机构和国家精神卫生系统专家的协商一致会议，以1)从临床和系统一级的角度确定问题的框架；2)确定有效和有问题的心理社会、药理学和系统做法；以及3)编写一份摘要出版物，提出改进当前做法的建议。共识会议的结果作为本出版物的基础，为治疗精神分裂症患者的临床医生提出了一系列广泛的建议。“综合治疗”是针对这一人群的循证治疗的新标准，并给出了帮助临床医生实施这种综合治疗的建议。具体建议包括筛查精神分裂症患者的药物使用障碍，评估改变的动机，管理双重诊断患者(如心血管疾病、肝脏并发症、肺癌、艾滋病毒和乙肝或丙型肝炎感染)的常见医疗条件，为这些患者选择最合适的药物以最大限度地提高安全性和最大限度地减少药物相互作用，对双重诊断患者使用循证心理社会干预措施(例如，双重诊断治疗、改良认知行为治疗、改良动机增强治疗和物质滥用管理模块)，以及治疗精神分裂症、物质使用障碍以及合并焦虑、抑郁和睡眠问题的关键药物治疗原则。最后，文章回顾了克服治疗障碍和促进这一患者群体的最佳结果所需的程序性和系统性变化。附录中提供了总结协商一致建议的算法。
National attention continues to focus on the need to improve care for individuals with co-occurring mental illnesses and substance use disorders, as emphasized in the 2003 President's New Freedom Commission Report on Mental Health and recent publications from the Substance Abuse and Mental Health Services Administration (SAMHSA). These reports document the need for best practice recommendations that can be translated into routine clinical care. Although efforts are underway to synthesize literature in this area, few focused recommendations are available that include expert opinion and evidence-based findings on the management of specific co-occurring disorders, such as schizophrenia and addiction. In response to the need for user-friendly recommendations on the treatment of schizophrenia and addiction, a consensus conference of experts from academic institutions and state mental health systems was organized to 1) frame the problem from clinical and systems-level perspectives; 2) identify effective and problematic psychosocial, pharmacological, and systems practices; and 3) develop a summary publication with recommendations for improving current practice. The results of the consensus meeting served as the foundation for this publication, which presents a broad set of recommendations for clinicians who treat individuals with schizophrenia." Integrated treatment" is the new standard for evidence-based treatment for this population and recommendations are given to help clinicians implement such integrated treatment. Specific recommendations are provided concerning screening for substance use disorders in patients with schizophrenia, assessing motivation for change, managing medical conditions that commonly occur in patients with dual diagnoses (eg, cardiovascular disease, liver complications, lung cancer, HIV, and hepatitis B or C infections) and selecting the most appropriate medications for such patients to maximize safety and minimize drug interactions, use of evidence-based psychosocial interventions for patients with dual diagnoses (eg, Dual Recovery Therapy, modified cognitive-behavioral therapy, modified motivational enhancement therapy, and the Substance Abuse Management Module), and key pharmacotherapy principles for treating schizophrenia, substance use disorders, and comorbid anxiety, depression, and sleep problems in this population. Finally the article reviews programmatic and systemic changes needed to overcome treatment barriers and promote the best outcomes for this patient population. An algorithm summarizing the consensus recommendations is provided in an appendix.