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№ 1 (2023)

ПСИХОФАРМАКОТЕРАПИЯ

Концепция раннего вмешательства в терапии шизофрении

https://doi.org/10.21265/PSYPH.2023.69.86.001

Опубликован 2023-03-30

  • Г. М. Усов
    • ,
  • Д.Ю. Коломыцев

Г. М. Усов
ФГБОУ ВО «Омский государственный медицинский университет» Министерства здравоохранения Российской Федерации

Д.Ю. Коломыцев
ФГБОУ ВО «Омский государственный медицинский университет» Министерства здравоохранения Российской Федерации

Аннотация

Изучение закономерностей естественного и модифицированного антипсихотиками течения шизофрении показало, что наиболее высокая эффективность лечения наблюдается на ранних стадиях заболевания. Это позволило сформулировать концепцию раннего вмешательства, включающего в себя терапию на этапах продрома (ультравысокий риск развития психоза) и первого психотического эпизода. В настоящее время детально разработаны организационные, терапевтические и реабилитационные вопросы оказания помощи пациентам с первым психотическим эпизодом, однако вопрос об эффективности вмешательства на этапе продрома остается дискуссионным. Существующие инструменты оценки риска развития психоза у пациентов из группы ультравысокого риска недостаточно точны, а возможности антипсихотиков в профилактике манифестации шизофрении, как минимум, ограничены. Вследствие этого интерес исследователей сосредоточен на изучении возможностей немедикаментозных вмешательств (в частности, когнитивно-поведенческой терапии) на этапе продрома, а пациентам с первым психотическим эпизодом рекомендуется проведение активной антипсихотической терапии с ранним назначением внутримышечных пролонгированных антипсихотиков второго поколения, позволяющей добиться максимального полной редукции симптоматики и восстановления социального функционирования.

Ключевые слова

шизофрения, раннее вмешательство, ультравысокий риск развития психоза, первый психотический эпизод, лечение шизофрении, пролонгированные внутримышечные антипсихотики

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