促进精神分裂症患者的康复

今年世界心理健康日的主题为“控制精神分裂症”，这对于我们这些治疗患病者的医生和患者本身都是非常有价值的信息。毕竟，有大约25%的精神分裂症患者报告完全康复，并有25%-35% 显著好转。这意味着，在有效治疗和干预下，将有高达50%的精神分裂症患者可以过上充实高效和满意的生活(Schizophr. Bull 2006;32:432-42)。

需要药物、意识和研究将精神分裂症变为一种可控制的疾病，这些工作必须结合患者的支持网络。此外，疾病的控制需要严格依照药物治疗，同时也需要依照对职业、营养、身体健康和避免药物滥用的要求。

世界心理健康联盟报告的作者在2014年世界心理健康日引用了两个例子，指出哪些类型的服务可能有助于精神分裂症患者过上充实高效的生活。喷泉之家是总部位于纽约的一个专业自助组织，帮助心理疾病患者从事安全工作、接受教育、做家务和维护健康。一些人指出，这种类型的康复中心可能成为一种“新兴的最佳实践” (Psychiatric Serv. 2012 [doi:10.1176/appi.ps.201200p10])。作者引用的另一种模式的例子描述的是索马里摩加迪休的无锁链行动。这一模型包含3个阶段。在第1阶段，按照字面意思去除对患者的锁链限制；在第2阶段，专业人士在家中访视患者，并提供家庭社会心理教育；在第3阶段，重点为“除去影响心理疾病患者人权的耻辱和限制的‘无形锁链’”。感谢这一行动，已有更多之前的患者报告生活在社区中，并且社区也越来越意识到严重心理疾病患者的权利问题。减少羞耻感是非常关键的，因为这一因素有能力决定精神分裂症的预后。让我们抛弃这些描述精神分裂症患者的词语，如“疯狂”、“危险”、“无法在家管理”、“无法工作”和“无法发挥社会功能”。

2012年，第5届关于人本医学的日内瓦会议整合喷泉之家和无锁链行动中提炼的很多原则，提出了一些建议。其中包括整合健康促进和疾病预防；通过多学科方法在对疾病的预防、诊断和治疗中提供健康服务；与临床管理和公共卫生的密切合作；在此类工作中构建公民社会。

在精神分裂中的管理中，全球的医疗保健工作者正面临巨大挑战。在发展中国家和发达国家执业的心理健康工作者必须在这场对抗精神分裂症的斗争中发挥教育、培养意识和动员各种资源的作用。精神分裂症仍是一个重要的全球心理健康问题，但控制这种疾病已成为可能。在未来的10-20年间，我们可能会更接近确定其病因，而这一发现很可能进而导致新的治疗标准诞生。

Gadit医生是多伦多大学的一位精神病学教授。

爱思唯尔版权所有  未经授权请勿转载

By: DR. AMIN A. MUHAMMAD GADIT

This year’s theme for World Mental Health Day, “living with schizophrenia,” is a valuable message for those of us who treat patients with the illness and for the patients themselves.

After all, about 25% of people with schizophrenia reportedly recover fully, and 25%-35% improve considerably. This means that with effective treatment and interventions, up to 50% of people with schizophrenia can live productive and satisfying lives (Schizophr. Bull 2006;32:432-42).

Dr. Amin A. Muhammad Gadit

The medications, awareness, and research needed to make schizophrenia a manageable disease must be combined with a supportive network for the patient. In addition, compliance in terms of strict adherence to medications is needed to keep the illness at bay, as are employment, nutrition, physical well-being, and avoidance of substance abuse.

Authors of the World Federation for Mental Health’s report on World Mental Health Day 2014 cited two examples of the kinds of services that can help patients with schizophrenia lead productive lives. Fountain House, a professional self-help program based in New York, assists people living with mental illness with securing jobs, schooling, housing, and wellness. Some suggest that these kinds of recovery centers might be an “emerging best practice” (Psychiatric Serv. 2012 [doi:10.1176/appi.ps.201200p10]).

The other example of a model cited by the authors describes the chain-free initiative in Mogadishu, Somalia. This model includes three phases. In phase 1, chains are literally removed from patients; in phase 2, professionals visit patients at home and provide family psychosocial education; and in phase 3, the focus is on “removing the ‘invisible chains’ of stigma and restrictions affecting the human rights of persons with mental illness.” Thanks to this initiative, more former patients reportedly are living in the community, and the community has greater awareness about the rights of people with severe mental illness.

Reducing stigma is critical, as this factor has the capacity to determine the prognosis of schizophrenia. Let’s toss out terms describing people with schizophrenia such as “crazy,” “dangerous,” “not manageable at home,” “unemployable,” and “unable to function in society.”

In 2012, the 5th Geneva Conference on Person-Centered Medicine made several recommendations that incorporate many of the principles promoted by Fountain House and the chain-free initiative. They include integrating health promotion and illness prevention; engaging health services in prevention, diagnosis, and treatment of diseases through multidisciplinary approaches; collaborating closely on clinical care and public health; engaging civil society in such efforts.

Health care workers across the globe face big challenges when it comes to managing schizophrenia. Those of us practicing medicine in developing and developed countries must educate, raise awareness, and mobilize resources in the fight against the illness.

Schizophrenia remains a major global mental health problem, but living with the illness has become possible. Perhaps 10 to 20 years down the road, we will be closer to identifying a cause, and this discovery, in turn, might lead to new horizons for treatment.

Dr. Gadit is a professor of psychiatry at the University of Toronto.