治疗检查表

Schizophrenia is a treatable brain illness ranging from mild to severe forms. It is very diverse in its causes, symptom severity and outcome similar to different types of Parkinson’s disease or cancer. Persons with schizophrenia may have some similar features, but they also have different experiences.

对于精神分裂症患者，了解和了解疾病本身至关重要。因此，考虑花一些时间了解该疾病的生物学和临床方面，并向您的精神科医生和治疗团队询问您能想到的所有问题。

Over the past 50 years, the medical care of schizophrenia has shifted from an in-patient institutional setting to community-based care, except when a psychotic relapse occurs and hospitalization is necessary. Today, many, but not all, people with schizophrenia, can achieve significant improvement in their illness and can return to vocational and social functioning, especially with the help of long-acting injectable antipsychotic medications, which protect against relapse better than pills. Sometimes, other medications– like antidepressants or anti-anxiety medications– may also be needed.

如需更多资源，我们邀请您查看我们的网站， https://curesz.org/what-is-schizophrenia/.

You should ask your psychiatrist to explain the illness and the various available treatments (including pills or intramuscular injections once every 1-6 months without having to take any pills) and he or she should assure you that all available treatments will be tried until you have achieved a return to your baseline. For about 30% of patients whose psychosis does not respond to the standard drug therapies, a medication called clozapine may be necessary. (See below, clozapine can eliminate hallucinations or delusions 50% of the time when other antipsychotics fail.) Once you start improving, your doctor and the mental health team should work with you to establish goals for the future, such as returning to school or work, spending more quality time with family and friends, and engaging in hobbies and other meaningful activities.

大多数精神分裂症患者的目标应该是康复，而不是继续患病和残疾。看看这些尽管患有精神分裂症但仍然茁壮成长的杰出人士的故事： https://curesz.org/survivors/

Adherence to antipsychotic medications in schizophrenia is very erratic leading to recurrence of psychosis, which are known to cause brain tissue loss, with clinical and functional deterioration and disability. Anosognosia (lack of insight) memory dysfunction, negative symptoms and substance use combine to preclude daily intake of oral medications. Fortunately, several long-acting injectable antipsychotics are available, eliminating the need to take pills every day. These include monthly injections (Invega Sustenna, Abilify Maintena, Aristada, Relprevv, Uzedy, Perseris), every 2 months (Abilify Asimtufii, Aristada), every 3 months (Invega Trinza) and every 6 months (Invega Hafyera). Ask your psychiatrist or nurse practitioner about these injectable formulations (some are intramuscular and some subcutaneous). They ensure that the brain receives medications without interruption, and are excellent alternatives to inconsistent adherence to daily pills. Avoiding psychotic relapses is critical to avoid brain damage, treatment resistance, incarceration and homelessness.

关于长效可注射抗精神病药物。
https://curesz.org/injectable-medications/

Studies show that several supplements added to antipsychotic medications during the acute episodes of psychosis may help in schizophrenia. These include omega 3 fatty acids (which may counteract the brain inflammation during psychosis), N-acetyl cysteine (which may help neutralize the harmful free radicals during psychosis), and vitamin D (which is important for brain development and ongoing health).

Since the 1990s, research has proven the effectiveness of CBT in depression, anxiety, and some symptoms of schizophrenia. It is considered one of the most effective psychotherapy methods.

About CBT from the Mayo Clinic.

About the “Recovery by Enabling Adult Carers at Home” (REACH) project: Psychosis REACH is a training that offers concrete, evidence-based skills for relatives and friends of individuals with psychotic disorders to better care for and relate to their loved ones. Psychosis REACH utilizes skills from Cognitive Behavioral Therapy (CBT) to teach caregivers to normalize and make sense of psychosis, use evidence-based coping strategies and develop key caring principles to communicate effectively with your loved one. To learn more, please visit our website: www.psychosisreach.org/

Clozapine can work when other antipsychotic medications fail to reduce persistent hallucinations or delusions. (These cases are called “treatment-resistant” or “refractory” cases).

Clozapine is associated with some side-effects. It can cause a reduction in white blood cell count in very rare cases (less than 1%). That’s why weekly white blood cells have to be measured with a quick blood test. Clozapine also may cause increased appetite and weight gain, sleepiness, constipation, and increased salivation. In high doses, it may cause other problems, such as diabetes or seizures, but most people do not need high doses.

Because patients on clozapine must be monitored for side effects, some psychiatrists avoid using clozapine– or use it rarely. In the United States, while 25% of patients may benefit from a trial of clozapine, less than 5% actually receive it from their psychiatrist and may need to be referred to a clozapine expert.

All patients who have not achieved full remission — which means they are asymptomatic or nearly free of delusions or hallucinations — with two different antipsychotic drugs, deserve a trial of clozapine.

氯氮平。 https://curesz.org/resources/clozapine-experts-panel/

Several studies show the benefit of exercise (walking 30 minutes a day) to help lose weight, improve cardiac health, and stimulate the production of new brain cells. Studies also show the benefit of a healthy diet (low calorie and low fat, with fiber from fruits, vegetables, and nuts) to avoid weight gain and reduce the risk of diabetes and high blood pressure, which are very common in schizophrenia.

大脑健康。 https://www.youtube.com/watch?v=kdeiZ4lmbd0

When your doctor prescribes a medication, ask what you should do if an intolerable side effect occurs. If you are experiencing side effects from your medication, do not stop your medications abruptly; get in touch with your doctor right away. The muscle stiffness can improve with a modest reduction of the dose. Discontinuing medications can lead to psychotic relapses, and in some cases, it can cause withdrawal symptoms like insomnia or agitation or muscle twitching. Additionally, psychiatric medications become less effective after each recurrence.

There are 12 new generation antipsychotic medications available today. If you are experiencing side effects, know that there may be another medication that may suit you better. Every person’s experience with medication is different because our bodies are biologically different.

心理教育和康复。
https://www.youtube.com/watch?v=zBleQcp4xGo

Tardive Dyskinesia (TD) is an involuntary movement disorder which is a serious neurological side effect of all antipsychotic medications, but especially older (and harsher) antipsychotics drugs like haloperidol. TD’s movements are often seen in the face, including the tongue lips, jaw and eyes (blinking/grimacing) but can also affect the neck, trunk, arms, fingers, legs, toes, and diaphragm.

Fortunately, two effective medications for TD were recently approved by the FDA. Valbenazine was approved by the FDA in April 2017, and deutetrabenazine was subsequently approved in August 2017. These medications can significantly reduce or eliminate TD movements.

Because the older antipsychotics like haloperidol are much more likely to cause acute muscle stiffness, tremor, rigidity or restlessness (in the first few hours, days, or weeks), and a high rate of TD (usually many years of use), they generally should not be used to treat schizophrenia or bipolar disorder. The newer antipsychotics have a much lower rate of TD.

迟发性运动障碍。
https://curesz.org/tardive-dyskinesia/