Каково соотношение риска и пользы длительной терапии антипсихотическими препаратами у пациентов с шизофренией?
Всемирная психиатрия. №2 2018
Каково соотношение риска и пользы длительной терапии антипсихотическими препаратами у пациентов с шизофренией?
Christoph U. Correll1-4, Jose M. Rubio1-3, John M. Kane1-3
1Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA; 2Hofstra Northwell School of Medicine, Hempstead, NY, USA; 3Feinstein Institute for Medical Research, Manhasset, NY, USA; 4Department of Child and Adolescent Psychiatry, Charite Universitatsmedizin, Berlin, Germany
Стр. 149-160
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Опубликовано: 12 ноября 2018
Аннотация / Abstract
a:2:{s:4:"TEXT";s:65535:"a:2:{s:4:"TYPE";s:4:"HTML";s:4:"TEXT";s:95983:"Перевод: Мурашко А.А. (Москва)
Редактура: к.м.н. Потанин С.С. (Москва)
Соотношение риска и пользы поддерживающей терапии антипсихотическими препаратами (АП) при шизофрении в долгосрочной перспективе было недавно поставлено под вопрос. В этой статье мы критически оценили литературу, посвященную долгосрочной пользе и эффективности такого лечения. Мы рассмотрели данные о нежелательных побочных эффектах, влиянии на заболеваемость и смертность, а также нейробиологические корреляты длительного применения АП. Наконец, мы изложили факторы, влияющие на соотношение риск–польза. Существуют убедительные доказательства эффективности применения АП в краткосрочной и среднесрочной перспективе после стабилизации острых психотических проявлений. Некоторое количество данных свидетельствует об изменении данного эффекта в долгосрочной перспективе. В большинстве исследований, хотя и не во всех, сообщается о снижении эффективности при длительной терапии АП. Однако результаты этих исследований противоречивы, особенно учитывая большую вероятность систематических ошибок, включая снижение со временем приверженности терапии. В то же время долгосрочные исследования, проведенные на национальных выборках, имеющих более низкий риск систематических ошибок, выявили преимущества длительной терапии АП, которая ассоциирована со сниженной смертностью среди лиц с шизофренией в сравнении с отсутствием лечения. Тем не менее длительный прием АП связан с развитием метаболических нарушений и поздней дискинезии. Последняя является очевидным клинически нежелательным нарушением функции головного мозга, наиболее вероятно – последствием длительного применения АП, преимущественно за счет возникновения гиперчувствительности дофаминовых рецепторов (других убедительных нейробиологических данных о природе данного состояния нет). Дополнительные психосоциальные вмешательства, по-видимому, необходимы для реабилитации пациентов. Однако нет да...
Перевод: Мурашко А.А. (Москва)
Редактура: к.м.н. Потанин С.С. (Москва)
Соотношение риска и пользы поддерживающей терапии антипсихотическими препаратами (АП) при шизофрении в долгосрочной перспективе было недавно поставлено под вопрос. В этой статье мы критически оценили литературу, посвященную долгосрочной пользе и эффективности такого лечения. Мы рассмотрели данные о нежелательных побочных эффектах, влиянии на заболеваемость и смертность, а также нейробиологические корреляты длительного применения АП. Наконец, мы изложили факторы, влияющие на соотношение риск–польза. Существуют убедительные доказательства эффективности применения АП в краткосрочной и среднесрочной перспективе после стабилизации острых психотических проявлений. Некоторое количество данных свидетельствует об изменении данного эффе...
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