Treatable clinical intervention targets for patients with schizophrenia
Treatable clinical intervention targets for patients with schizophrenia
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DOI：
10.1016/j.schres.2019.07.016
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发表时间：
2019-09-01
影响因子：
4.5
通讯作者：
Waite, Felicity
中科院分区：
文献类型：
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作者：
Freeman, Daniel;Taylor, Kathryn M.;Waite, Felicity
背景：精神病患者的治疗方法需要重大改进。我们的改善方法是双重的：针对可治疗的精神病经历的假定因果机制，以及患者希望治疗的精神病经历。这导致更大的治疗参与和临床受益。告知精神卫生服务的提供，我们评估了存在的可治疗的因果机制和患者的治疗preferences.Methods：非情感性精神病患者参加NHS精神卫生服务完成评估偏执，幻觉，焦虑回避，担心，自尊，失眠，分析推理，心理健康，和治疗preferences.Results：1809例患者参加。53.4%的患者有严重的偏执症状，48.2%的患者有频繁的声音。在因果机制中，67.7%的人存在严重的担忧，64.5%的人在广场恐惧水平上回避，55.9%的人分析推理困难，50.1%的人失眠，44.3%的人心理健康状况不佳，36.6%的人有强烈的消极自我信念，19.2%的人有弱的积极自我信念。治疗目标偏好为：感觉更快乐（63.2%），担心更少（63.1%），增加自信（62.1%），增加活动（59.6%），改善决策（56.5%），感觉更安全（53.0%），睡眠更好（52.3%）和应对声音（45.3%）。目前的偏执狂和/或幻觉的患者有较高水平的因果因素，并希望这些difficulties treated.Conclusions：非情感性精神病患者有高水平的可治疗的问题，如广场恐惧回避，担心，低自尊，失眠，他们会喜欢这些困难的治疗。成功地治疗这些困难也可能减少精神病的经验，如偏执。(C)2019作者由爱思唯尔公司出版
Background: Treatment approaches for patients with psychosis need major improvement. Our approach to improvement is twofold: target putative causal mechanisms for psychotic experiences that are treatable and also that patients wish treated. This leads to greater treatment engagement and clinical benefit. To inform mental health service provision we assessed the presence of treatable causal mechanisms and patient treatment preferences.Methods: Patients with non-affective psychosis attending NHS mental health services completed assessments of paranoia, hallucinations, anxious avoidance, worry, self-esteem, insomnia, analytic reasoning, psychological well-being, and treatment preferences.Results: 1809 patients participated. Severe paranoia was present in 53.4% and frequent voices in 48.2%. Of the causal mechanisms, severe worry was present in 67.7%, avoidance at agoraphobic levels in 64.5%, analytic reasoning difficulties in 55.9%, insomnia in 50.1%, poor psychological well-being in 44.3%, strongly negative self-beliefs in 36.6%, and weak positive self-beliefs in 19.2%. Treatment target preferences were: feeling happier (63.2%), worrying less (63.1%), increasing self-confidence (62.1%), increasing activities (59.6%), improving decision-making (56.5%), feeling safer (53.0%), sleeping better (52.3%), and coping with voices (45.3%). Patients with current paranoia and/or hallucinations had higher levels of the causal factors and of wanting these difficulties treated.Conclusions: Patients with non-affective psychosis have high levels of treatable problems such as agoraphobic avoidance, worry, low self-esteem, and insomnia and they would like these difficulties treated. Successful treatment of these difficulties is also likely to decrease psychotic experiences such as paranoia. (C) 2019 The Authors. Published by Elsevier B.V.