The treatment of acute schizophrenia without drugs: an investigation of some current assumptions.
The treatment of acute schizophrenia without drugs: an investigation of some current assumptions.
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不使用药物治疗急性精神分裂症：对当前一些假设的调查。
DOI：
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发表时间：
1977
影响因子：
17.7
通讯作者：
J. Strauss
中科院分区：
文献类型：
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作者：
W. Carpenter;T. McGlashan;J. Strauss
精神分裂症的治疗方法已使用多年，并提供了丰富的有关症状学和治疗效果的信息来源。然而，在严格的研究方法论的意义上，这种信息基础往往被视为轶事而被忽视，其影响也是如此。精神分析和相关的心理学方法在精神分裂症患者治疗中的作用已经减弱。在制定适当的具体变化措施时，涉及到令人生畏的复杂问题。这与心理治疗的目的密切相关，直到最近，很少有人注意到这种评估问题（4 - 8）。因此。比如这是可能的），以证明药物是更有效的比心理-J化疗减少偏执病人的bellig-jeeberg。但目前还没有办法评估这两种治疗方式对这名患者的治疗效果。精神分裂症的药物治疗在精神病学中非常重要。然而，我们相信，精神分裂症的治疗已经变得如此广泛地以药物为导向，以至于对探索替代治疗方法的一个重大障碍是伊森。从1950年代到1950年代，情况发生了逆转，当时对心理治疗哲学的承诺对药物创新构成了严重的阻力。Klein（9）注意到，对精神失常的病人自动和立即给予神经癫痫药，往往先于甚至排除诊断评估。这种普遍的和过早的取消对精神分裂症的最佳治疗的影响反映在这样一个事实上，即数百万人将精神抑制剂作为他们治疗的唯一重要组成部分。"精神分裂症知识的局限性考虑到我们对精神分裂症知之甚少，我们临床方法的缩小尤其令人担忧。这些限制包括以下几点：I.我们对精神分裂症的病因几乎一无所知。尽管有证据表明某些形式的精神分裂症有遗传因素，但我们对这一成分的性质一无所知，也不知道它如何导致脆弱性，或者在多大程度上解释了显性精神分裂症的差异。目前，作者在美国国立卫生研究院（NIH）的一个强调心理社会治疗和严格限制药物使用的项目中，对49例急性精神分裂症患者的病程进行了研究，并将其与另一项单独研究中接受"常规"治疗的73例类似患者进行了对比。一年后NIH组的随访结果和另一个...
proaches to schizophrenia have been used for years ·f and have provided a rich source of information on phe-:~ nomenology and treatment effects. However, in the ab-;i, sence of rigorous research methodology this informa-;~ tion base is often dismissed as anecdotal, and the influ-:. ; ;jJ ence of psychoanalysis and related psychological; approaches on the treatment of schizophrenic patients l : has waned. There are formidable intricacies involved;: in developing appropriate measures of change specifi-.;~ cally relevant to the aims of psychotherapy, and until '~ recently little attention has been paid to such assess: ment problems (4-8). Thus. for example. it is possible) to demonstrate that drugs are more effective than psy-J chotherapy in reducing a paranoid patient's bellig-j erency. but there is no way to assess the effectiveness~:1 of either mode of treatment on this palient's capacity~ for i n t i m a c y. i Pharmacological treatment of schizophrenia is ex-}; traordinarily important in psychiatry. We bel ieve, however er, that the treatment of schizophrenia has become ~ so extensively drug oriented that a significant impediment has a,:isen to the exploration of alternati ve therapeutic approaches. The situation has reversed from;l~ the 1950s, when a commitment to psychological treat-'~ ment philosophies posed a serious resistance to phar-t macological innovations. Klein (9) has noted that the A automatic and immediate administration of neurolep-' tics to disturbed patients often precedes and precludes even a diagnostic evaluation. This widespread and premature foreclosure on the optimal treatment of schizo-phrenia is reflected by the fact that millions of people take neuroleptics as the only important component of their treatment. " LIMITATIONS IN KNOWLEDGE OF SCHIZOPHRENIA This narrowing of our clinical approach is especially~ alarming considering how little we know about schizoq phrenia. These limitations include the following: I. We know virtually nothing about the etiology 0 schizophrenia. Despite evidence for a genetic contrib tion in some forms of schizophrenia, we know nothi about the nature of this component, how it may con tribute to vulnerability, or to what extent it account for the variance in manifest schizophrenia. At present The authors examine the course of49 acute schizophrenic patients in a program at the National Institutes a/Health (NIH) emphasizing psychosocial treatment and sharply limiting the use ofmedication and contrast it with that oI73 similar patients receiving "usual" treatment in a separate study. Follow-up of the NIH group at one year and the other …