精神分裂症的预后较差。即使接受治疗,患者通常也会有残留症状,且有 25%-33% 的患者出现药物治疗耐受。[211]Essali A, Al-Haj Haasan N, Li C, et al. Clozapine versus typical neuroleptic medication for schizophrenia. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD000059.http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD000059.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/19160174?tool=bestpractice.com 这些患者中大部分会出现终身残疾,且只有很少数患者在急性发作期间能够独立生活。该病的治疗必须要非常全面,需考虑药物治疗的依从性、社会支持、病例管理及三级预防的方法。[212]Ananth J, Parameswaran S, Hara B. Drug therapy in schizophrenia. Curr Pharm Des. 2004;10(18):2205-17.http://www.ncbi.nlm.nih.gov/pubmed/15281896?tool=bestpractice.com
此外,社会功能训练、认知行为疗法、认知辅导及社会认知训练提出了社会康复的几个关键组成部分,与精神药理学相结合,对功能恢复区有帮助,并最终作为一条途径,帮助患者超越仅仅是症状的稳定,可实现更佳的结局。[213]Kern RS, Glynn SM, Horan WP, et al. Psychosocial treatments to promote functional recovery in schizophrenia. Schizophr Bull. 2009 Mar;35(2):347-61.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2659313/http://www.ncbi.nlm.nih.gov/pubmed/19176470?tool=bestpractice.com[214]Horan WP, Kern RS, Shokat-Fadai K, et al. Social cognitive skills training in schizophrenia: an initial efficacy study of stabilized outpatients. Schizophr Res. 2009 Jan;107(1):47-54.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2653055/http://www.ncbi.nlm.nih.gov/pubmed/18930378?tool=bestpractice.com
在影响疾病病程的因素中,家庭环境、物质滥用及未治疗的时间是最重要的可预测结局可的因素。[44]Loebel AD, Lieberman JA, Alvir JM, et al. Duration of psychosis and outcome in first-episode schizophrenia. Am J Psychiatry. 1992 Sep;149(9):1183-8.http://www.ncbi.nlm.nih.gov/pubmed/1503130?tool=bestpractice.com[45]Malla AK, Norman RM, Manchanda R, et al. One year outcome in first episode psychosis: influence of DUP and other predictors. Schizophr Res. 2002 Apr 1;54(3):231-42.http://www.ncbi.nlm.nih.gov/pubmed/11950548?tool=bestpractice.com[46]Norman RM, Malla AK. Duration of untreated psychosis: a critical examination of the concept and its importance. Psychol Med. 2001 Apr;31(3):381-400.http://www.ncbi.nlm.nih.gov/pubmed/11305847?tool=bestpractice.com[215]Kane JM, McGlashan TH. Treatment of schizophrenia. Lancet. 1995 Sep 23;346(8978):820-5.http://www.ncbi.nlm.nih.gov/pubmed/7545770?tool=bestpractice.com[216]Wyatt RJ. Neuroleptics and the natural course of schizophrenia. 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Social support and schizophrenia. Schizophr Bull. 1981;7(1):58-72.http://www.ncbi.nlm.nih.gov/pubmed/7233113?tool=bestpractice.com[50]Ciompi L. Catamnestic long-term study on the course of life and aging of schizophrenics. Schizophr Bull. 1980;6(4):606-18.http://www.ncbi.nlm.nih.gov/pubmed/7444392?tool=bestpractice.com[51]McGlashan TH. Duration of untreated psychosis in first-episode schizophrenia: marker or determinant of course? Biol Psychiatry. 1999 Oct 1;46(7):899-907.http://www.ncbi.nlm.nih.gov/pubmed/10509173?tool=bestpractice.com[52]Larsen TK, Moe LC, Vibe-Hansen L, et al. Premorbid functioning versus duration of untreated psychosis in 1 year outcome in first-episode psychosis. Schizophr Res. 2000 Sep 29;45(1-2):1-9.http://www.ncbi.nlm.nih.gov/pubmed/10978867?tool=bestpractice.com[53]Larsen TK, McGlashan TH, Johannessen JO, et al. Shortened duration of untreated first episode of psychosis: changes in patient characteristics at treatment. Am J Psychiatry. 2001 Nov;158(11):1917-9.http://www.ncbi.nlm.nih.gov/pubmed/11691702?tool=bestpractice.com[54]Harrigan SM, McGorry PD, Krstev H. Does treatment delay in first-episode psychosis really matter? Psychol Med. 2003 Jan;33(1):97-110.http://www.ncbi.nlm.nih.gov/pubmed/12537041?tool=bestpractice.com[55]Craig TJ, Bromet EJ, Fennig S, et al. Is there an association between duration of untreated psychosis and 24-month clinical outcome in a first-admission series? Am J Psychiatry. 2000 Jan;157(1):60-6.http://www.ncbi.nlm.nih.gov/pubmed/10618014?tool=bestpractice.com[56]Robinson DG, Woerner MG, Alvir JM, et al. Predictors of treatment response from a first episode of schizophrenia or schizoaffective disorder. Am J Psychiatry. 1999 Apr;156(4):544-9.http://www.ncbi.nlm.nih.gov/pubmed/10200732?tool=bestpractice.com[57]Robinson D, Woerner MG, Alvir JM, et al. Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder. 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