Past and present progress in the pharmacologic treatment of schizophrenia.
Past and present progress in the pharmacologic treatment of schizophrenia.
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DOI：
10.4088/jcp.10r06264yel
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发表时间：
2010-09
期刊：
影响因子：
--
通讯作者：
Correll CU
中科院分区：
文献类型：
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作者：
Kane JM;Correll CU
尽管在过去几十年中治疗取得了进展，但精神分裂症仍然是最严重的精神疾病之一，在相当大比例的患者中与慢性复发过程和明显的功能障碍相关。在过去的50年中，精神分裂症治疗的药理学进展的历史概述。其次是审查目前的发展，在优化精神分裂症患者的治疗和结果。强调了方法论挑战、潜在的解决方案以及特别需要进一步研究的领域。虽然反应，缓解和恢复的治疗目标已被定义得更加统一，一个良好的“有效性”的措施映射到功能的结果仍然缺乏。此外，该领域必须在将基于测量的方法从研究转移到临床实践方面取得进展。关于是否应该使用第一代或第二代抗精神病药物以及使用哪种药物的争论仍在继续。然而，特别是在考虑个体不良反应特征时，不能坚持将第一代和第二代抗精神病药区分为统一类别，需要更有区别的观点和治疗选择。所需的个性化治疗方法需要考虑当前症状、合并症、既往治疗反应和不良反应，以及患者的选择和期望。需要平衡药物治疗的急性和长期目标和效果。到目前为止，氯氮平是难治性患者唯一的循证治疗方法，抗精神病药物多药治疗和其他增强策略的作用充其量仍不清楚。为了发现具有增强/更广泛疗效和改善耐受性的新型治疗方法，并实现个性化治疗，需要阐明疾病发展和进展、症状改善和副作用发展的潜在机制。
Despite treatment advances over the past decades, schizophrenia remains one of the most severe psychiatric disorders that is associated with a chronic relapsing course and marked functional impairment in a substantial proportion of patients. A historical overview of the pharmacologic advances in the treatment of schizophrenia over the past 50 years is presented. This is followed by a review of the current developments in optimizing the treatment and outcomes in patients with schizophrenia. Methodological challenges, potential solutions, and areas of particular need for further research are highlighted. Although treatment goals of response, remission and recovery have been defined more uniformly, a good “effectiveness” measure mapping onto functional outcomes is still lacking. Moreover, the field has to advance in transferring measurement based approaches from research to clinical practice. There is an ongoing debate whether and which first- or second-generation antipsychotics should be used. However, especially, when considering individual adverse effect profiles, the differentiation into first- and second-generation antipsychotics as unified classes can not be upheld and a more differentiated view and treatment selection is required. The desired, individualized treatment approach needs to consider current symptoms, comorbid conditions, past therapeutic response and adverse effects, as well as patient choice and expectations. Acute and long-term goals and effects of medication treatment need to be balanced. To date, clozapine is the only evidence based treatment for refractory patients, and the role of antipsychotic polypharmacy and other augmentation strategies remains unclear, at best. To discover novel treatments with enhanced/broader efficacy and improved tolerability, and to enable personalized treatment, the mechanisms underlying illness development and progression, symptomatic improvement and side effect development need to be elucidated.