Elderly patients with schizophrenia and depression: diagnosis and treatment.
Elderly patients with schizophrenia and depression: diagnosis and treatment.
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DOI：
10.3371/csrp.4.4.4
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发表时间：
2011-01
影响因子：
--
通讯作者：
Kasckow JW
中科院分区：
文献类型：
--
作者：
Felmet K;Zisook S;Kasckow JW
患有精神分裂症和抑郁症状的老年患者的治疗给临床医生带来了许多挑战。目前精神分裂症患者抑郁症状的分类包括：精神分裂症患者发生的重性抑郁发作，不属于分裂情感性障碍、分裂情感性障碍和精神分裂症伴亚综合征性抑郁，其中抑郁症状不符合重性抑郁的标准。研究表明，任何这些抑郁症状的存在都会对精神分裂症谱系疾病患者的生活产生负面影响。本文的目的是回顾老年精神分裂症谱系障碍患者并发抑郁症状的相关文献，指导精神卫生专业人员更好地了解精神分裂症患者抑郁症状的诊断和治疗。患有精神分裂症和抑郁症状的老年患者的治疗包括首先重新评估诊断，以确保症状不是由合并症、代谢问题或药物引起的。如果排除这些因素，药物与社会心理干预相结合是治疗患有精神分裂症和抑郁症状的老年患者的重要方法。需要对每位患者进行仔细评估，以确定哪种抗精神病药物最适合他们的治疗；第二代抗精神病药是最常用的抗精神病药。抗抑郁药物的增强治疗对于患有精神分裂症和抑郁症状的老年患者可能有帮助。然而，需要更多的药理学和心理社会干预研究，以更好地了解如何治疗这一老年患者群体。
The treatment of older patients with schizophrenia and depressive symptoms poses many challenges for clinicians. Current classifications of depressive symptoms in patients with schizophrenia include: Major Depressive Episodes that occur in patients with schizophrenia and are not classified as schizoaffective disorder, Schizoaffective Disorder, and Schizophrenia with subsyndromal depression in which depressive symptoms do not meet criteria for Major Depression. Research indicates that the presence of any of these depressive symptoms negatively impacts the lives of patients suffering from schizophrenia-spectrum disorders. The purpose of this paper is to review the literature related to older patients with schizophrenia-spectrum disorders and co-occurring depressive symptoms, and to guide mental health professionals to better understand the diagnosis and treatment of depressive symptoms in patients with schizophrenia. The treatment of elderly patients with schizophrenia and depressive symptoms includes first reassessing the diagnosis to make sure symptoms are not due to a comorbid condition, metabolic problems or medications. If these are ruled out, pharmacological agents in combination with psychosocial interventions are important treatments for older patients with schizophrenia and depressive symptoms. A careful assessment of each patient is needed in order to determine which antipsychotic would be optimal for their care; second-generation antipsychotics are the most commonly used antipsychotics. Augmentation with an antidepressant medication can be helpful for the elderly patient with schizophrenia and depressive symptoms. More research with pharmacologic and psychosocial interventions is needed, however, to better understand how to treat this population of elderly patients.