The clinical characterization of the patient with primary psychosis aimed at personalization of management

被引:193
作者
Maj, Mario [1 ]
van Os, Jim [2 ,3 ,4 ]
De Hert, Marc [5 ,6 ]
Gaebel, Wolfgang [7 ,8 ]
Galderisi, Silvana [1 ]
Green, Michael F. [9 ,10 ]
Guloksuz, Sinan [3 ,11 ]
Harvey, Philip D. [12 ]
Jones, Peter B. [13 ,14 ]
Malaspina, Dolores [15 ]
McGorry, Patrick [16 ,17 ]
Miettunen, Jouko [18 ,19 ,20 ]
Murray, Robin M. [4 ]
Nuechterlein, Keith H. [21 ,22 ]
Peralta, Victor [23 ]
Thornicroft, Graham [24 ,25 ]
van Winkel, Ruud [3 ,6 ,26 ]
Ventura, Joseph [9 ]
机构
[1] Univ Campania L Vanvitelli, Dept Psychiat, Naples, Italy
[2] Univ Med Ctr Utrecht, Brain Ctr Rudolf Magnus, Dept Psychiat, Utrecht, Netherlands
[3] Maastricht Univ, Med Ctr, Sch Mental Hlth & Neurosci, Dept Psychiat & Neuropsychol, Maastricht, Netherlands
[4] Kings Coll London, Inst Psychiat Psychol & Neurosci, London, England
[5] Katholieke Univ Leuven, Univ Psychiat Ctr, Kortenberg, Belgium
[6] Univ Antwerp, Antwerp Hlth Law & Eth Chair, Antwerp, Belgium
[7] Heinrich Heine Univ Dusseldorf, LVR Klinikum Dusseldorf, Med Frac, Dept Psychiat & Psychotherapy, Dusseldorf, Germany
[8] WHO Collaborating Ctr Qual Assurance & Empowermen, Dusseldorf, Germany
[9] Univ Calif Los Angeles, Dept Psychiat & Biobehav Sci, Semel Inst Neurosci & Human Behav, Los Angeles, CA 90024 USA
[10] Desert Pacific Mental Illness Res Educ & Clin Ctr, Dept Vet Affairs, Los Angeles, CA USA
[11] Yale Sch Med, Dept Psychiat, New Haven, CT USA
[12] Univ Miami, Miller Sch Med, Dept Psychiat, Div Psychol, Miami, FL 33136 USA
[13] Univ Cambridge, Dept Psychiat, Cambridge, England
[14] Cambridgeshire & Peterborough NHS Fdn Trust, Cambridge, England
[15] Ichan Med Sch Mt Sinai, Dept Psychiat & Neurosci, New York, NY USA
[16] Orygen, Parkville, Vic, Australia
[17] Univ Melbourne, Ctr Youth Mental Hlth, Parkville, Vic, Australia
[18] Univ Oulu, Ctr Life Course Hlth Res, Oulu, Finland
[19] Oulu Univ Hosp, Med Res Ctr Oulu, Oulu, Finland
[20] Univ Oulu, Oulu, Finland
[21] Univ Calif Los Angeles, Semel Inst Neurosci & Human Behav, Geffen Sch Med, Los Angeles, CA 90024 USA
[22] Univ Calif Los Angeles, Dept Psychol, Los Angeles, CA USA
[23] Inst Invest Sanitaria Navarra, Serv Navarro Salud, Mental Hlth Dept, Pamplona, Spain
[24] Kings Coll London, Inst Psychiat Psychol & Neurosci, Ctr Global Mental Hlth, London, England
[25] Kings Coll London, Inst Psychiat Psychol & Neurosci, Ctr Implementat Sci, London, England
[26] Katholieke Univ Leuven, Univ Psychiat Ctr, Leuven, Belgium
关键词
Primary psychosis; schizophrenia; personalization of treatment; psychosocial interventions; recovery; positive dimension; negative dimension; neurocognition; social cognition; social functioning; psychiatric antecedents; psychiatric comorbidities; physical comorbidities; family history; obstetric complications; environmental exposures; protective factors; resilience; practical needs; internalized stigma; SEVERE MENTAL-ILLNESS; MAJOR DEPRESSIVE DISORDER; SCHIZOPHRENIA SPECTRUM DISORDERS; COGNITIVE-BEHAVIORAL THERAPY; IMPROVE PHYSICAL HEALTH; STRESSFUL LIFE EVENTS; QUALITY-OF-LIFE; TERM-FOLLOW-UP; NEGATIVE SYMPTOMS; SOCIAL COGNITION;
D O I
10.1002/wps.20809
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
The current management of patients with primary psychosis worldwide is often remarkably stereotyped. In almost all cases an antipsychotic medica-tion is prescribed, with second-generation antipsychotics usually preferred to first-generation ones. Cognitive behavioral therapy is rarely used in the vast majority of countries, although there is evidence to support its efficacy. Psychosocial interventions are often provided, especially in chronic cases, but those applied are frequently not validated by research. Evidence-based family interventions and supported employment programs are seldom implemented in ordinary practice. Although the notion that patients with primary psychosis are at increased risk for cardiovascular diseases and diabetes mellitus is widely shared, it is not frequent that appropriate measures be implemented to address this problem. The view that the management of the patient with primary psychosis should be personalized is endorsed by the vast majority of clinicians, but this personalization is lacking or inadequate in most clinical contexts. Although many mental health services would declare themselves "recovery-oriented", it is not common that a focus on empowerment, identity, meaning and resilience is ensured in ordinary practice. The present paper aims to address this situation. It describes systematically the salient domains that should be considered in the characterization of the individual patient with primary psychosis aimed at personalization of management. These include positive and negative symptom dimensions, other psychopathological components, onset and course, neurocognition and social cognition, neurodevelopmental indicators; social functioning, quality of life and unmet needs; clinical staging, antecedent and concomitant psychiatric conditions, physical comorbidities, family history, history of obstetric complications, early and recent environmental exposures, protective factors and resilience, and internalized stigma. For each domain, simple assessment instruments are identified that could be considered for use in clinical practice and included in standardized decision tools. A management of primary psychosis is encouraged which takes into account all the available treatment modalities whose efficacy is supported by research evidence, selects and modulates them in the individual patient on the basis of the clinical characterization, addresses the patient's needs in terms of employment, housing, self-care, social relationships and education, and offers a focus on identity, meaning and resilience.
引用
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页码:4 / 33
页数:30
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