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題 名 | Rharmacological Prevention of Relapse=藥物與疾病復發之預防 |
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作 者 | Lader,Malcolm; | 書刊名 | The Kaohsiung Journal of Medical Sciences |
卷 期 | 14:7 1998.07[民87.07] |
頁 次 | 頁448-457 |
專 輯 | Schizophrenia-Basic Clinical Aspects |
分類號 | 418.21 |
關鍵詞 | 藥物; 疾病復發; 精神分裂病; Schizophrenia; Relapse; Pharmacological prevention; |
語 文 | 英文(English) |
中文摘要 | 所謂疾病復發是指「疾病處於部份復原後的再自發情況」,此現象往往是精神分裂病的主要特徵之一,尤其是精神症狀明顯的再度出現時或是整體性產生社交失衡時,意味著需要調整治療,其中包括再度入院治療或需危機處理。「復發」最好被視為疾病嚴重性之連續而非「偶發事件」。影響復發之因素包括重大生活事件與家庭種種因素。抗精神藥物往往能保護後者因素,但非前者。復發可能是透過一些非特異性刺激機轉所致。目前已確定藥物之效應在於延後而非預防再發,可延後至少兩倍再發間期;然而,大部分之病患始終會再病發。藥物之不良作用亦會造成病患之一大負擔,尤其會影響其生活,特別有關運動障礙、情緒低落及藥物順從性不佳。在所有椎體外徑副作用中,遲發性遲緩動作是一項漸嚴重且長期的問題。其他非椎體外徑副作用亦包括體重增加與內分泌之變化。對於漸嚴重且藥物順從性不佳的病患,長效針劑比口服藥較理想,然而其副作用也會更顯著 。在兩難中之選擇,主要以提高藥物之順從性為考量。無論如何,規律的訪視是有助益的。至目前為止,藥物動態之研究仍未十分明確。在一些特殊的個案中,高劑量之治療曾被建議過;也許對某些個案有助益,但不能一視同仁,同時高劑量亦有其危險性之存在。低劑量及間歇性停止治療曾被評估過,但未達到預期的療效,也許可能適用於病症較輕者。上述治療方式有賴於能否提早發現不易被觀察的再發症狀,然而復發往往也不一定有前驅症狀。目前正朝研發更特別療效的藥品,例如比clozapine更安全有效的產品及具其他療效藥品如Benzodiazepine等。總之,時下最亟待突破研究的領域莫過於藥物與非藥物之交互作用,特別是誘發等因素。 |
英文摘要 | Relapse is the “return of a disease after partial recovery”, and is a major feature of schizophrenia disorder. It can be defined in terms of need for change in treatment, including re-hospitalization or crisis intervention, the re-emergence of florid psychotic features, or gross social decompensation. Relapse is best viewed as continuum of severity rather than as discrete “attacks”. Factors influencing relapse include major life events and the family constellation. Antipsychotic drugs protect against the latter but not the former, and relapse may be mediated by non-specific arousal mechanisms. The efficacy of drug treatment in postponing rather than preventing relapse is well established. The interval between relapses is prolonged at least two-fold, but in the long run most patients relapse. Unwanted effects of antipsychotic drugs can be a burden to patients, impairing quality of life. In particular, movement disorders and subjective dysphoria may be marked, as may compliance. Of these EPS, tardive dyskinesia is the most serious on long term use. Non-EPS long term effects include weight gain and endocrine changes. Depot medication has advantages over oral medication in the more ill, less compliant patients. Side effects may, however, be more marked. The greatest pain is in improved compliance but the regular supervision of the patient is also helpful. Pharmacokinetic issues are poorly understood. High and mega-dose strategies have been advocated. High doses may be needed in some patients, but megadoses are rarely justified and may be hazardous. Low dose and intermittent therapy have been evaluated but are not as successful as hoped. Some less ill patients may benefit. These schedules depend on the identification of prodromata of relapse which is not always easy, nor are relapses necessarily preceded by prodromata. Newer drugs are being developed rapidly in the search for a safer clozapine, the only antipsychotic with definitely enhanced efficacy. Other drugs which have been reevaluated include the benzodiazepines. However, the area of greatest priority in research is that of interactions, particularly potentiation, between drug and non-drug treatments. |
本系統中英文摘要資訊取自各篇刊載內容。