Current approaches to treatments for schizophrenia spectrum disorders, part II: psychosocial interventions and patient-focused perspectives in psychiatric care.
Current approaches to treatments for schizophrenia spectrum disorders, part II: psychosocial interventions and patient-focused perspectives in psychiatric care.
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DOI：
10.2147/ndt.s49263
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发表时间：
2013
影响因子：
3.2
通讯作者：
Wong WK
中科院分区：
文献类型：
--
作者：
Chien WT;Leung SF;Yeung FK;Wong WK
精神分裂症是一种致残性精神疾病，与认知、情感、心理社会和职业功能障碍有关。越来越多的证据表明，对精神分裂症患者进行心理社会干预，作为药物或常规精神护理的辅助手段，可以减少精神病症状和复发，并改善患者的长期结果，如康复、缓解和疾病进展。这篇对文献的批判性回顾是为了确定对精神分裂症患者进行心理社会干预的常见方法。还探讨和讨论了治疗规划和结果，以更好地从以人为本的角度了解这些干预措施的效果，如他们感知的生活质量和满意度，以及他们对所接受的治疗或服务的接受度和依从性。我们搜索了主要的医疗保健数据库，如EMBASE，MEDLINE，和QicLIT，并从这些数据库中找到了相关的英文文献。对他们的参考列表进行筛选，如果研究符合使用随机对照试验或系统回顾设计的标准，对所使用的干预措施进行明确描述，并拥有主要诊断为精神分裂症的研究样本，则选择研究。心理社会干预的五种主要方法被用于精神分裂症的治疗：认知疗法(认知行为和认知补救疗法)、心理教育、家庭干预、社会技能训练和自信的社区治疗。在应用于精神分裂症患者的这五种方法中，大多数在症状控制或减少、功能水平和/或复发率方面显示出令人满意的短期至中期临床疗效。然而，这五种方法之间的比较效果还没有得到很好的研究，因此，我们无法清楚地了解这些干预措施的优越性。除了患者复发，在这些患者中，这些方法对大多数心理社会结局的长期影响(例如，两年)并不是很确定。尽管患者对治疗和护理的看法越来越受到关注，但没有多少研究评估了干预措施对这一角度的影响，即使他们这样做了，结果也是不确定的。总而言之，目前对精神分裂症进行心理社会干预的方法都有其优点和缺点，特别是表明关于长期影响的证据有限。为了改善精神分裂症患者的长期预后，未来的治疗策略应侧重于风险识别、早期干预、以人为本的治疗、与家庭照顾者的伙伴关系，以及将循证的心理社会干预纳入现有服务。
Schizophrenia is a disabling psychiatric illness associated with disruptions in cognition, emotion, and psychosocial and occupational functioning. Increasing evidence shows that psychosocial interventions for people with schizophrenia, as an adjunct to medications or usual psychiatric care, can reduce psychotic symptoms and relapse and improve patients’ long-term outcomes such as recovery, remission, and illness progression. This critical review of the literature was conducted to identify the common approaches to psychosocial interventions for people with schizophrenia. Treatment planning and outcomes were also explored and discussed to better understand the effects of these interventions in terms of person-focused perspectives such as their perceived quality of life and satisfaction and their acceptability and adherence to treatments or services received. We searched major health care databases such as EMBASE, MEDLINE, and PsycLIT and identified relevant literature in English from these databases. Their reference lists were screened, and studies were selected if they met the criteria of using a randomized controlled trial or systematic review design, giving a clear description of the interventions used, and having a study sample of people primarily diagnosed with schizophrenia. Five main approaches to psychosocial intervention had been used for the treatment of schizophrenia: cognitive therapy (cognitive behavioral and cognitive remediation therapy), psychoeducation, family intervention, social skills training, and assertive community treatment. Most of these five approaches applied to people with schizophrenia have demonstrated satisfactory levels of short- to medium-term clinical efficacy in terms of symptom control or reduction, level of functioning, and/or relapse rate. However, the comparative effects between these five approaches have not been well studied; thus, we are not able to clearly understand the superiority of any of these interventions. With the exception of patient relapse, the longer-term (eg, >2 years) effects of these approaches on most psychosocial outcomes are not well-established among these patients. Despite the fact that patients’ perspectives on treatment and care have been increasingly concerned, not many studies have evaluated the effect of interventions on this perspective, and where they did, the findings were inconclusive. To conclude, current approaches to psychosocial interventions for schizophrenia have their strengths and weaknesses, particularly indicating limited evidence on long-term effects. To improve the longer-term outcomes of people with schizophrenia, future treatment strategies should focus on risk identification, early intervention, person-focused therapy, partnership with family caregivers, and the integration of evidence-based psychosocial interventions into existing services.