{"id":4763,"date":"2022-12-26T15:30:41","date_gmt":"2022-12-26T15:30:41","guid":{"rendered":"https:\/\/curesz.org\/?page_id=4763"},"modified":"2023-11-15T15:02:32","modified_gmt":"2023-11-15T20:02:32","slug":"the-7-catastrophic-consequences-of-psychotic-recurrences","status":"publish","type":"page","link":"https:\/\/curesz.org\/zh\/the-7-catastrophic-consequences-of-psychotic-recurrences\/","title":{"rendered":"\u7cbe\u795e\u75c5\u590d\u53d1\u7684 7 \u79cd\u707e\u96be\u6027\u540e\u679c"},"content":{"rendered":"

<\/span><\/div>

\u4ea8\u5229\u00b7\u7eb3\u65af\u9c81\u62c9\u535a\u58eb
\nCURESZ \u57fa\u91d1\u4f1a\u79d1\u5b66\u603b\u76d1<\/strong><\/p>\n<\/div><\/div><\/div>

\u7cbe\u795e\u75c5\u590d\u53d1\u7684\u4e03\u5927\u707e\u96be\u6027\u540e\u679c<\/p>\n

It is very unfortunate when individuals with schizophrenia relapse repeatedly.\u00a0 The #1 cause for the recurrence of psychosis is either inconsistent adherence to antipsychotic (AP) medications or total non-adherence (1).\u00a0 The reasons for poor adherence in schizophrenia are related to the illness itself, and patients should not be blamed.<\/p>\n

\u5bfc\u81f4\u4f9d\u4ece\u6027 (2) \u7684\u7cbe\u795e\u5206\u88c2\u75c7\u75c7\u72b6\u5305\u62ec\uff1a1) \u5931\u8ba4\u75c7<\/strong>, or the lack of insight that one is very sick with delusions and hallucinations, leading to patient rejection of medication 2) \u8ba4\u77e5\u56f0\u96be<\/strong> \u5305\u62ec\u4e25\u91cd\u7684\u8bb0\u5fc6\u969c\u788d\uff0c\u5bfc\u81f4\u5fd8\u8bb0\u53c2\u52a0 AP\uff0c3) \u9634\u6027\u75c7\u72b6<\/strong>, including apathy, lack of motivation (avolition) and loss of the ability to do many things, including taking medications every day, 4) \u591a\u7591<\/strong> AP \u836f\u7269\u7684\u5e38\u89c1\u526f\u4f5c\u7528\u662f\u4e2d\u6bd2\u7684\u8bc1\u636e\uff0c5) \u9152\u7cbe\u548c\u836f\u7269\u4f7f\u7528<\/strong> which are very common in persons with schizophrenia living in the community, and being intoxicated or stoned precludes taking prescription medication.\u00a0 The combination of all those factors inevitably leads to a high rate of medication nonadherence after discharge from the first hospitalization.<\/p>\n

\u5c31\u50cf 1 \u578b\u7cd6\u5c3f\u75c5\u6216\u9ad8\u8840\u538b\u4e00\u6837\uff0c\u5fc5\u987b\u6bcf\u5929\u670d\u836f\u5426\u5219\u6709\u590d\u53d1\u7684\u98ce\u9669\uff0c\u7cbe\u795e\u5206\u88c2\u75c7\u60a3\u8005\u5fc5\u987b\u6bcf\u5929\u4e0d\u95f4\u65ad\u5730\u670d\u7528\u53e3\u670d\u836f\u3002\u4e00\u9879\u5df2\u53d1\u8868\u7684\u7814\u7a76\u8868\u660e\uff0cAP \u8840\u6db2\u6c34\u5e73\u4ec5\u4e0b\u964d 25%\uff08\u8fd9\u610f\u5473\u7740\u6bcf 4 \u5929\u7f3a\u5c11\u4e00\u6b21\u5242\u91cf\uff09\u5c31\u8db3\u4ee5\u5bfc\u81f4\u7cbe\u795e\u5206\u88c2\u75c7\u590d\u53d1 (3)\u3002<\/p>\n

Long-acting injectable (LAI) APs were developed in the 1970\u2019s, precisely to solve the problem of non-adherence with oral medication.\u00a0 However, due to the delay in scientific advances about the brain-damaging effects of psychosis (which appeared 3 decades later), clinicians back then were completely unaware that psychosis is associated with the dangers of recurring psychosis and resultant brain damage. They also believed that patients should \u201cmake their own decisions,\u201d despite the well-known fact that the decision-making region of the brain (frontal lobe) is impaired in schizophrenia. Patients were even led to regard LAI treatment as \u201cstigmatizing\u201d and as a \u201cpunishment\u201d for multiple relapses, so they resisted the LAIs. Now LAIs are regarded as a most compassionate and effective therapeutic approach to save patients with schizophrenia from psychosis-induced brain damage.<\/p>\n

\u5927\u7ea6\u5728 2000 \u5e74\uff0c\u7cbe\u795e\u75c5\u5b66\u795e\u7ecf\u79d1\u5b66\u7814\u7a76\u8868\u660e\uff0c\u7531\u4e8e\u795e\u7ecf\u708e\u75c7\u548c\u81ea\u7531\u57fa (5) \u8fd9\u4e24\u8005\u90fd\u4f1a\u635f\u5bb3\u7070\u8d28\u548c\u767d\u8d28\uff0c\u7cbe\u795e\u75c5\u4f1a\u7834\u574f\u8111\u7ec4\u7ec7\u5e76\u5bfc\u81f4\u8111\u840e\u7f29 (4)\u3002\u6bcf\u6b21\u7cbe\u795e\u75c5\u590d\u53d1\u90fd\u4f1a\u5bfc\u81f4\u5927\u8111\u7ed3\u6784\u548c\u529f\u80fd\u6076\u5316\u3002\u8fd9\u53ef\u4ee5\u9632\u6b62\u60a3\u6709\u7cbe\u795e\u5206\u88c2\u75c7\u7684\u4eba\u6062\u590d\u5230\u9996\u53d1\u7cbe\u795e\u75c5 (FEP) \u4e4b\u524d\u7684\u57fa\u7ebf\u6c34\u5e73\uff0c\u8fd9\u5bf9\u4e8e\u9752\u6625\u671f\u540e\u671f\u6216 20 \u5c81\u51fa\u5934\u7684\u5e74\u8f7b\u4eba\u6765\u8bf4\u662f\u975e\u5e38\u60b2\u60e8\u7684\u3002<\/p>\n

\u4ee5\u4e0b\u662f\u7531\u4e8e\u4f9d\u4ece\u6027\u5dee\u5bfc\u81f4\u7684\u7cbe\u795e\u75c5\u53cd\u590d\u53d1\u4f5c (6) \u7684 7 \u79cd\u707e\u96be\u6027\u540e\u679c\uff1a<\/p>\n

    \n
  • \u8fde\u63a5\u6240\u6709\u5927\u8111\u533a\u57df\u5e76\u5f62\u6210\u81ea\u6211\u7edf\u4e00\u4f53\u7684\u5e7f\u6cdb\u7684\u6709\u9ad3\u7ea4\u7ef4\u7f51\u7edc\uff08\u7ea6 137,000 \u82f1\u91cc\uff09\u7684\u8111\u7ec4\u7ec7\u4e22\u5931\u548c\u8111\u840e\u7f29\u4ee5\u53ca\u89e3\u4f53\u3002<\/li>\n
  • Treatment-resistance patients respond to low doses of AP in the first-episode of psychosis (FEP) but need higher and higher dose with each psychotic relapse until eventually they become completely treatment-resistant (and will need Clozapine, which most patients never have access to). The brain structure deteriorates successively with each episode and that\u2019s why APs that previously worked no longer do so.<\/li>\n
  • \u529f\u80fd\u969c\u788d\uff0c\u4ee5\u53ca\u65e0\u6cd5\u8fd4\u56de\u5b66\u6821\u6216\u5927\u5b66\u6216\u5de5\u4f5c\uff0c\u65e0\u8bba\u60a3\u8005\u5728 FEP \u4e4b\u524d\u505a\u4ec0\u4e48\u3002\u56e0\u6b64\uff0c\u968f\u7740\u53cd\u590d\u590d\u53d1\uff0c\u8fd9\u4e9b\u5e74\u8f7b\u4eba\u53d8\u5f97\u5b8c\u5168\u6b8b\u75be\uff0c\u800c\u4e0d\u662f\u6210\u4e3a\u793e\u4f1a\u7684\u751f\u4ea7\u6027\u6210\u5458\u3002<\/li>\n
  • When individuals with schizophrenia become psychotic and behave erratically, sometimes they are killed by police, and many more are arrested and jailed, and often sentenced to prison. They no longer get admitted to state hospitals (because they have all been shuttered), and so are surrounded by armed guards instead of doctors, nurses and social workers who compassionately provide them with medical care instead of being thrown into a prison with murderers and rapists.<\/li>\n
  • \u8bb8\u591a\u4eba\u5e76\u6ca1\u6709\u610f\u8bc6\u5230\u60a3\u6709\u7cbe\u795e\u5206\u88c2\u75c7\u7684\u5e74\u8f7b\u4eba\u5728\u590d\u53d1\u65f6\u7684\u81ea\u6740\u7387\u975e\u5e38\u9ad8\u3002\u4e00\u4e9b\u7814\u7a76\u62a5\u544a\u79f0\uff0c\u4e0e\u666e\u901a\u4eba\u7fa4\u4e2d\u540c\u9f84\u5e74\u8f7b\u4eba\u76f8\u6bd4\uff0c\u81ea\u6740\u6b7b\u4ea1\u7387\u9ad8\u51fa 10,000% (7)\u3002<\/li>\n
  • Non-adherence can lead to drug abuse, a chaotic lifestyle and living on the sidewalks of large cities, with risk of becoming victims of crime.<\/li>\n
  • Psychosis can cause unusual behavior, and poor dress and grooming, which intensify the public\u2019s negative bias against serious mental illness.<\/li>\n<\/ul>\n

    \u7136\u800c\uff0c\u4e0e\u8fd9\u79cd\u4ee4\u4eba\u6cae\u4e27\u7684\u7ed3\u679c\u76f8\u53cd\uff0c\u7cbe\u795e\u5206\u88c2\u75c7\u60a3\u8005\u5374\u770b\u5230\u4e86\u5e0c\u671b\u548c\u597d\u6d88\u606f\u3002\u5c3d\u65e9\u4f7f\u7528 LAI\uff0c\u5373\u5728\u7b2c\u4e00\u6b21\u4f4f\u9662\u540e\u7acb\u5373\u4f7f\u7528\uff0c\u53ef\u4ee5\u5728\u9632\u6b62\u6076\u5316\u65b9\u9762\u4ea7\u751f\u5de8\u5927\u5dee\u5f02\u3002\u6709\u5df2\u53d1\u8868\u7684\u7814\u7a76\u8868\u660e\uff0c\u5982\u679c\u5f00\u59cb LAI\uff0cFEP \u540e\u7b2c\u4e00\u5e74\u7684\u590d\u53d1\u7387 650% \u4f4e\u4e8e\u63a5\u53d7\u53e3\u670d AP \u7684\u60a3\u8005\u7684\u590d\u53d1\u7387 (8)\u3002\u6211\u4e2a\u4eba\u6709\u4e00\u4e9b\u60a3\u8005\u5728\u6539\u7528\u53ef\u6ce8\u5c04 AP \u540e\u8fde\u7eed 5 \u5e74\u6ca1\u6709\u590d\u53d1\u3002\u9884\u9632\u590d\u53d1\u81f3\u5173\u91cd\u8981\uff0c\u56e0\u4e3a\u6700\u8fd1\u7684\u7814\u7a76\u8868\u660e\u6b8b\u75be\u5b9e\u9645\u4e0a\u662f\u5728\u590d\u53d1\u540e\u5f00\u59cb\u7684 \u7b2c\u4e8c<\/u>, \u4e0d\u662f\u7cbe\u795e\u75c5\u7684\u7b2c\u4e00\u96c6 (9)\u3002\u56e0\u6b64\uff0c\u9884\u9632\u4e8c\u6b21\u53d1\u4f5c\u662f\u7cbe\u795e\u5206\u88c2\u75c7\u7f13\u89e3\u548c\u5eb7\u590d\u7684\u5173\u952e\u3002\u56e0\u6b64\uff0c\u5728\u7cbe\u795e\u5206\u88c2\u75c7\u9996\u6b21\u4f4f\u9662\u540e\u7acb\u5373\u4f7f\u7528 LAI AP \u53ef\u4ee5\u9884\u9632\u5927\u591a\u6570\u60a3\u8005\u7684\u7cbe\u795e\u5206\u88c2\u75c7\u6076\u5316\u548c\u6076\u5316\u8fc7\u7a0b (10)\u3002<\/p>\n

    \u4f7f\u7528\u7b2c\u4e8c\u4ee3 LAI \u914d\u65b9\u8fd8\u6709\u5176\u4ed6\u91cd\u8981\u4f18\u52bf\u3002 24 \u9879\u5df2\u53d1\u8868\u7684\u7814\u7a76\u62a5\u544a\u79f0\uff0c\u5b83\u4eec \u795e\u7ecf\u4fdd\u62a4<\/u> \uff08\u5373\u5e2e\u52a9\u4fdd\u6301\u8111\u7ec4\u7ec7\u7684\u5b8c\u6574\u6027\uff09\uff0811\uff09\u3002\u6b64\u5916\uff0c\u745e\u5178\u7684\u4e00\u9879\u4e3a\u671f 7 \u5e74\u7684\u540e\u7eed\u7814\u7a76\u62a5\u544a\u79f0\uff0c\u7b2c\u4e8c\u4ee3 LAI \u6297\u7cbe\u795e\u75c5\u836f\u7269\u4e0e \u6700\u4f4e\u6b7b\u4ea1\u7387<\/u> \u4ece\u6240\u6709\u539f\u56e0\uff0812\uff09\u3002\u9274\u4e8e\u7cbe\u795e\u5206\u88c2\u75c7\u7684\u8fc7\u65e9\u6b7b\u4ea1\u7387\u5f88\u9ad8\uff0c\u8fd9\u4e00\u70b9\u975e\u5e38\u91cd\u8981\u3002<\/p>\n

    In summary, until a cure for schizophrenia is discovered, the best way to give patients a chance to return to their baseline and avoid the tragic, life-altering consequences, is to use second-generation LAIs immediately after discharge from the first hospitalization. Yet, inexplicably, this is rarely done, and 99% of clinicians in the country prescribe pills and do not use LAI APs for several years until patients have already relapsed several times.\u00a0 By that time, the patients have already lost substantial amounts of brain tissue and have become disabled and criminalized and incarcerated.\u00a0 Imagine how much different the landscape of schizophrenia would be if clinicians prevented any further episode of psychosis after the first one.\u00a0 Many young people with a diagnosis of schizophrenia may be able to return to their baseline, further their education, get a job, get married, raise a family and exercise their constitutional right to pursue happiness (13).<\/p>\n

    \u4ea8\u5229\u00b7A\u00b7\u7eb3\u65af\u9c81\u62c9\uff0c<\/p>\n

    \u79d1\u5b66\u4e3b\u4efb<\/p>\n

    \u53c2\u8003\uff1a<\/u><\/strong><\/p>\n

      \n
    1. Valligan DI \u7b49\u4eba\uff1a \u60a3\u8005\u66f4\u559c\u6b22\u4f9d\u4ece\u6027<\/u> 11:449-468, 2018<\/li>\n
    2. \u7eb3\u65af\u9c81\u62c9\u54c8\uff1a \u76ee\u524d\u7684\u7cbe\u795e\u75c5\u5b66<\/u> 16:4-7, 2017<\/li>\n
    3. Subotnik KL \u7b49\u4eba\uff1a \u7f8e\u56fd\u7cbe\u795e\u75c5\u5b66\u6742\u5fd7<\/u> 168:286-292, 2011<\/li>\n
    4. Cahn W \u7b49\u4eba\uff1a Arch Gen \u7cbe\u795e\u75c5\u5b66<\/u> 59:1002-1010, 2002<\/li>\n
    5. Kohler-Torsberg O \u7b49\u4eba\uff1a \u7cbe\u795e\u75c5\u5b66\u524d\u6cbf<\/u> 11:1-3, 2020<\/li>\n
    6. \u7eb3\u65af\u9c81\u62c9\u54c8\uff1a \u76ee\u524d\u7684\u7cbe\u795e\u75c5\u5b66<\/u> 20:9-12, 2021<\/li>\n
    7. Zaheer J \u7b49\u4eba\uff1a \u7cbe\u795e\u5206\u88c2\u75c7\u7814\u7a76<\/u> 222:282-38, 2020<\/li>\n
    8. Subotnik KL \u7b49\u4eba\uff1a \u7f8e\u56fd\u533b\u5b66\u4f1a\u7cbe\u795e\u75c5\u5b66<\/u> 72:822-829, 2015<\/li>\n
    9. Taipale H \u7b49\u4eba\uff1a \u67f3\u53f6\u5200\u7cbe\u795e\u75c5\u5b66<\/u> 9:271-279, 2022<\/li>\n
    10. \u7eb3\u65af\u9c81\u62c9\u54c8\uff1a \u76ee\u524d\u7684\u7cbe\u795e\u75c5\u5b66<\/u> 21:6-9, 2022<\/li>\n
    11. Chen AT \u7b49\u4eba\uff1a \u7cbe\u795e\u5206\u88c2\u75c7\u7814\u7a76<\/u> 208:1-7, 2019<\/li>\n
    12. Taipale H \u7b49\u4eba\uff1a \u7cbe\u795e\u5206\u88c2\u75c7\u7814\u7a76<\/u> 197:274-280, 2018<\/li>\n
    13. Nasrallah HA \u7b49\u4eba\uff1a \u76ee\u524d\u7684\u7cbe\u795e\u75c5\u5b66<\/u> 20:14-16, 202<\/li>\n<\/ol>\n<\/div><\/div><\/div><\/div><\/div>
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