OUTPATIENT TREATMENT--TARGETED VS MAINTENANCE MEDICATION

在这个项目的前五年，我们比较了 有针对性的早期干预策略的有效性 采用早期干预策略的抗精神病药物治疗 (增加剂量)补充了正在进行的维护 抗精神病药治疗。我们迄今的经验对 工作在目前的应用中提出了几种方式。第一, 我们已经开发出一种快速有效的药物干预方法 在复发时，患者被分配到无药物或 实验药物状态。因为有针对性的早期干预 治疗努力是可行和有效的，后果是 无效的试验性或安慰剂治疗不一定是严重的 临床状态恶化。第二，我们对 早期干预，有针对性的抗精神病药物策略表明 高度敏感的前驱综合征检测的可能性 包括与复发有关的假阳性症状 通常还包括易患精神病的精神病 抗焦虑药物治疗。第三，我们现在有一支训练有素的 经验丰富的临床人员，具有既定的处理能力 与慢性和严重精神病患者在 对照临床研究的方案要求。第四，我们有 获得了进行以下工作所需的后勤经验 门诊临床试验。 正如最初所述，该项目的具体目标是 测定两种药物治疗的相对疗效 精神分裂症门诊患者的护理方法之一，涉及 针对症状恶化的抗精神病药物的靶向应用 另一起涉及使用相同的药物治疗 维护目的。从一开始，它的可行性和伦理 非连续的定向方法引起了激烈的争论； 然而，这一替代战略的潜在优势是 积极不顺从的患者令人信服，而且有 越来越多的人意识到安慰剂控制了持续用药 试验没有解决这一项目的核心假设。 这种方法是一种可行的选择的可能性 有相当大一部分精神分裂症患者 足够有吸引力，值得在随机情况下进行经验评估 作业，比较治疗研究。 眼下的目标是确定是否大幅减少 使用抗精神病药物可以在不产生不利影响的情况下实现 影响病程和结局状态，如症状所反映 临床失代偿和医院护理的需要。

During the first five years of this project, we compared the efficacy of a targeted, early intervention strategy using neuroleptic medication with a strategy using early intervention (increased dosage) that supplemented ongoing maintenance neuroleptic therapy. Our experience to date is useful for the work proposed in the current application in several ways. First, we have developed a rapid, effective pharmacologic intervention at relapse for patients assigned to either drug-free or experimental drug status. Since targeted, early intervention treatment efforts are feasible and effective, the consequences of ineffective experimental or placebo treatment need not be severe deterioration in clinical state. Second, our experience with the early intervention, targeted neuroleptic strategy suggests the likelihood that highly sensitive detection of a prodromal syndrome includes symptoms that are false-positive with respect to relapse and often includes psychopathology likely to be susceptible to anxiolytic drug treatment. Third, we now have a trained and experienced clinical staff with established competence in dealing with chronically and severely mentally ill patients within the protocol demands of controlled clinical studies. Fourth, we have gained the logistical experience necessary for conducting outpatient clinical trials. As originally described, the specific aims of the project were to determine the relative effectiveness of two pharmacotherapeutic approaches to the care of schizophrenic outpatients, one involving the targeted use of neuroleptic drugs for symptom exacerbation and the other involving the use of these same drugs for maintenance purposes. At the outset, the feasibility and ethics of the noncontinuous targeted approach were heatedly debated; however, the potential advantages of this alternative strategy for the actively noncompliant patient were compelling, and there was a growing appreciation that placebo controlled continuous drug trials had not addressed the central hypothesis of this project. The possibility that this approach would be a feasible alternative for a substantial proportion of schizophrenic patients was sufficiently attractive to merit empirical evaluation in a random assignment, comparative treatment study. The immediate goal was to ascertain if a substantial reduction in the use of neuroleptic drugs could be achieved without adversely affecting course and outcome status as reflected in symptomatic clinical decompensation and the need for hospital care.