• 主题
高级搜索  >
历史搜索 清空历史
首页> 外文期刊>The journal of clinical psychiatry >Expert consensus guideline series. Optimizing pharmacologic treatment of psychotic disorders. Introduction: methods, commentary, and summary.
【24h】

Expert consensus guideline series. Optimizing pharmacologic treatment of psychotic disorders. Introduction: methods, commentary, and summary.

机译：专家共识指南系列。 优化精神障碍的药理治疗。 简介：方法，评论和摘要。

获取原文
获取原文并翻译 | 示例
           
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

摘要

Objectives: A growing number of atypical antipsychotics are available for clinicians to choose from in the treatment of psychotic disorders. However, a number of important questions concerning medication selection, dosing and dose equivalence, and the management of inadequate response, compliance problems, and relapse have not been adequately addressed by clinical trials. To aid clinical decision-making, a consensus survey of expert opinion on the pharmacologic treatment of psychotic disorders was undertaken to address questions not definitively answered in the research literature.Method: Based on a literature review, a written survey was developed with 60 questions and 994 options. Approximately half of the options were scored using a modified version of the RAND 9-point scale for rating the appropriateness of medical decisions. For the other options, the experts were asked to write in answers (e.g., average doses) or check a box to indicate their preferred answer. The survey was sent to 50 national experts on the pharmacologic treatment of psychotic disorders, 47 (94%) of whom completed it. In analyzing the responses to items rated on the 9-point scale, consensus on each option was defined as a non random distribution of scores by chi-square "goodness-of-fit"test. We assigned a categorical rank (first line/preferred choice,second line/alternate choice, third line/usually inappropriate) to each option based on the 95% confidence interval around the mean rating. Guideline tables indicating preferred treatment strategies were then developed for key clinical situations. Results: The expert panel reached consensus on 88% of the options rated on the 9-point scale. The experts overwhelmingly endorsed the atypical antipsychotics for the treatment of psychotic disorders. Risperidone was the top choice for first-episode and multi-episode patients, with the other newer atypicals rated first line or high second line depending on the clinical situation.Clozapine and a long-acting injectable atypical (when available)were other high second line options for multi-episode patients.The expert's dosing recommendations agreed closely with the package inserts for the drugs, and their estimates of dose equivalence among the antipsychotics followed a linear pattern.The experts considered 3-6 weeks an adequate antipsychotic trial, but would wait a little longer (4-10 weeks) before making a major change in treatment regimen if there is a partial response. The experts recommended trying to improve response by increasing the dose of atypical and depot antipsychotics before switching to a different agent; there was less agreement about increasing the dose of conventional antipsychotics before switching, probably because of concern about side effects at higher doses. If it is decided to switch because of inadequate response, risperidone was the expert's first choice to switch to, no matter what drug was initially tried. Although there was some disparity in the expert's recommendations concerning how many agents to try before switching to clozapine, the expert's responses suggest that switching to clozapine should be Clozapine was also the antipsychotic of choice for patients with suicidal behavior. When switching oral antipsychotics,the experts considered cross-titration the preferred strategy. When switching to an injectable antipsychotic, the experts stressed the importance of continuing the oral antipsychotic until therapeutic levels of the injectable agent are achieved.The experts considered psychosocial interventions the first choice strategy for partially compliant patients, with pharmacologic interventions the first choice for patients with clear evidence of noncompliance. However, because it can be difficult to distinguish partially compliant from noncompliant patients, the editors recommended combining psychosocial and pharmacologic interventions to improve compliance whenever possible.When patients relapse because of compliance problems or if
机译：目标：临床医生可以选择越来越多的非典型抗精神病药物，可以选择精神病患者。然而，临床试验没有充分解决了一些关于药物选择，给药和剂量等效的重要问题，给药和剂量等效以及响应，合规性问题和复发的管理。为了援助临床决策，对精神病疾病药理治疗的专家意见进行了共识调查，以解决在研究文献中不明确回答的问题。 994选项。使用RAND 9点规模的修改版本评分大约一半的选择，以便评估医学决策的适当性。对于其他选项，要求专家签订答案（例如，平均剂量）或检查一个框以表明他们的首选答案。该调查被送到50名国家专家对精神病疾病的药理治疗，47名（94％）完成它。在分析对9分量表上评定的项目的响应时，每个选项的共识被定义为Chi-Square“拟合良好”测试的非随机分布。我们根据平均额定值的95％置信区间分配了一个分类的等级（第一行/首选选择，第二行/备选选择，第三行/通常是不合适的）。然后为关键临床局势开发了指南表明表明优选治疗策略。结果：专家小组达成了9分尺度额定期权的88％的共识。专家压倒性地赞同非典型抗精神病药治疗精神病障碍。 Risperidone是一集发作和多集患者的最佳选择，另一个新的非典型额定的第一线或高第二线根据临床局势。柑橘和长效的注射非典型（当可用时）是其他高二线多剧集患者的选择。专家与药物包裹刀片仔细一致的专家的给药建议，以及他们对抗精神病学之间的剂量等效的估计，遵循线性模式。专家考虑了3-6周的足够抗精神病药审判，但会等待如果存在部分反应，在治疗方案进行重大变化之前，稍长（4-10周）。专家建议通过在切换到不同的代理之前增加非典型和仓库抗精神病药剂量的剂量来提高响应;关于在切换前增加常规抗精神病药剂量的剂量较少，可能是因为对较高剂量的副作用令人担忧。如果由于响应不足而决定切换，则Risperidone是专家的首选，无论最初尝试了什么药物。虽然专家的建议有一些差异有关在切换到氯氮平之前尝试有多少代理商，但专家的回答表明，转向氯氮平应该是氯氮平也是自杀行为患者选择的抗精神病。在切换口头抗透视核素时，专家认为交叉滴定首选战略。在切换到可注射的抗抗精神病症时，专家们强调，继续持续口服抗精神病药直到达到可注射剂的治疗水平。专家们认为心理社会干预部分合规患者的第一选择策略，具有药理学干预患者的首选患者明确违规证据。但是，由于难以区分部分符合持有的患者，因此编辑推荐将心理社会和药理学干预结合在尽可能随时改善遵守情况。由于遵守问题而复发时，或者

著录项

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号